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Child Care Registration Form
Phone: 262-782-3040; Email: SchoolOffice@ChristTheLordBrookfield.org
Hours: 11:30 a.m. - 5:30 p.m.; Rate Per Hour: $5.00; Additional Sibling: $2.50. Billing: Invoices are emailed to the beginning of each month.
Always update the registration form if your schedule changes. Thank you.
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* Required
STUDENT INFORMATION
First & Last Name
*
Your answer
Grade
*
Choose
K3
K4
K
1
2
3
4
5
6
7
8
HEALTH CONCERNS
Ex: Regular medications, specific health concerns, allergies, including drug reactions, or other important information.
Health Concerns - Yes or No? If yes, specify under "Other"
*
Yes
No
Other:
Required
CHILD CARE REQUEST
Start Date
*
MM
/
DD
/
YYYY
Arrival Time
Time
:
AM
PM
Pick Up Time
*
Time
:
AM
PM
RECURRING
*
Yes
No
Specify all that apply
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
PARENT VOLUNTEER
Volunteer - Yes or No? If Yes, specify under "Other" the type of task (ex: coach, pioneer leader, art assistant, etc.)
*
Yes
No
Other:
PARENT INFORMATION
Parent First & Last Name
*
Your answer
Parent Primary Phone (include area code)
*
Your answer
Parent Email Address
*
Your answer
OTHER CONTACT PICKING UP
Other Contact First & Last Name
Your answer
Other Contact Primary Phone (include area code)
Your answer
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