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.
STUDENT INFORMATION
First & Last Name *
Grade *
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" *
Required
CHILD CARE REQUEST
Start Date *
MM
/
DD
/
YYYY
Arrival Time
Time
:
Pick Up Time *
Time
:
RECURRING *
Specify all that apply *
Required
PARENT VOLUNTEER
Volunteer - Yes or No? If Yes, specify under "Other" the type of task (ex: coach, pioneer leader, art assistant, etc.) *
PARENT INFORMATION
Parent First & Last Name *
Parent Primary Phone (include area code) *
Parent Email Address *
OTHER CONTACT PICKING UP
Other Contact First & Last Name
Other Contact Primary Phone (include area code)
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