2017 Annual Conference Childcare Registration Form
A conference member needing care for his or her child(ren) age 10 or under is asked to provide the information below. The deadline is May 18, 2017.
Parent(s) Name
Your answer
Telephone Number
Your answer
Address
Your answer
Name of Child #1
Your answer
Age of Child #1
Your answer
Name of Child #2
Your answer
Age of Child #2
Your answer
Name of Child #3
Your answer
Age of Child #3
Your answer
Childcare is needed for the following days
Required
Special needs or information we need to be aware of?
Your answer
If the weather is appropriate, is your child(ren) allowed to play outside?
Required
I understand that meals costs for children aged 3-17 are $4 for lunch and $7 for dinner (you will need to add this to your registration fee based on need).
Required
I understand that my child(ren) will be picked up during meal times.
Required
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