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 on a monthly basis.
* 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, special health problems, allergies, including drug reactions, other important information.
Health Concerns - Yes or no? If yes, specify
Your answer
CHILD CARE REQUEST
Start Date
*
MM
/
DD
/
YYYY
Pick Up When
*
Time
:
AM
PM
REOCCURING
*
Yes
No
Specify all that apply
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
PARENT INFORMATION
Parent First & Last Name
*
Your answer
Parent Primary Phone (include area code)
*
Your answer
OTHER CONTACT PICKING UP
Other Contact First & Last Name
Your answer
Other Contact Primary Phone (include area code)
Your answer
Submit
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