COV4 Childcare Registration Form
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Email
Emergency Contact - Relationship to Youth
Youth's preferred spoken language
Youth's preferred gender pronoun
Disability Justice Resources?
Allergies or Dietary Restrictions?
Medical Considerations or Other Important Info?
What type of activities or workshops would you like to see happen in the childcare space?
What time will you need childcare?
Thursday, 5pm - 7pm
Thursday, 7pm - 9pm
Friday, 9am - 10:30am
Friday, 10:30am - 12:30pm
Friday, 2pm - 3:30pm
Friday, 3:30pm - 6pm
Friday, 6pm - 8pm
Saturday, 9am - 10:30am
Saturday, 10:30am - 12:30pm
Saturday, 2pm - 3:30pm
Saturday, 3:30pm - 6pm
Saturday, 6pm - 8pm
Sunday, 9am - 10:30am
Sunday, 10:30am - 12:30pm
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