2017 Gilmanton Summer CHILD CARE CLINIC
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Gilmanton 2017 Child Care Clinic Registration, July 24-26, 10:30 AM-1:00 PM
Participant First Name:
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Age
Participant First and Last Name:
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Parent/Guardian Name
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Phone Number
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e-mail address
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Participant's Race
Participant's Ethnicity
Gender
Registration Fees are $15.00 and the participant can bring to the first day of class. Confidential requests for partial or full scholarships are available.
Media/Photo Release: I, as parent/guardian, give permission for UW-Extension to use photographs which may include my child for Child Care Clinic educational display or media release. I understand that photographs of my child will NOT be taken or used without my permission.
Special Accommodations Needed:
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