March 18, 2019 Child Care
Dear Parents and Guardians, please use this form to register your child/children for child care during this evening event. Please fill out the form completely! We need all the information completely filled in. Please email Marisa Bel at mbel@bethlehemschools.org if you have any questions and/or need to provide additional information.

After registering, you will receive an email confirming your child(ren)'s participation. Additional information regarding parking, drop-off and pick-up procedures, and other details will be shared in this follow-up email.

As space is limited, please send an email should your plans change and you no longer plan to use this service.

We hope this service is helpful for you and your family!

Email address *
Your Full Name *
Your answer
Your cell phone number(s): Parents/guardians must have a personal cell phone with them and be available to respond if needed. *
Your answer
Name of first child who will participate in the child care program: *
Your answer
Child's Age *
Your answer
School this child attends: *
Name of child's classroom or homeroom teacher: *
Your answer
Does this child have any allergy, medical/physical or special needs that we should know about? Please describe in full:
Your answer
Name of second child who will participate in the child care program:
Your answer
2nd child's age:
Your answer
Which school does 2nd child attend?
Name of 2nd child's classroom or homeroom teacher:
Your answer
Does this 2nd child have any allergy, medical/physical or special needs that we should know about? Please describe in full:
Your answer
Other children who will participate:
Your answer
Ages:
Your answer
Name(s) of school child(ren) attends:
Your answer
Name of other child(ren)'s classroom or homeroom teacher(s):
Your answer
Does this child have any allergy, medical/physical or special needs that we should know about? Please describe in full:
Your answer
Is there any other information you would like us to know?
Your answer
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