2024 Mondovi Child Care Clinic - June 24, 25, 26, 27, 12:30-3:00PM and 28th 10:00AM-Noon Community Room

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2024 Mondovi Child Care Clinic - June 24, 25, 26, 27, 12:30-3:00PM and 28th 10:00AM-Noon Community Room - Enter Door #5

This training is available for any students age 11 and older, and students who will turn 11 soon. Payment of $10.00 can be brought the first day of the class. Please register by: Wednesday, June 19th

Contact mary.campbellwood@wisc.edu or call 608-685-6252 with any questions.

Child Name *

Child's age *

Parent/Guardian Name(s) *

Parent/Guardian Emails *

Phone Number(s) *

Media Release - Do you give permission for your child to be included in photos to be used in newspaper articles, or shared on an Extension website or publication? *

Yes

What is your child's gender? *

Female

Male

Prefer not to respond

What is your child's race? *

American Indian or Alaska Native

Asian

Native Hawaiian and other Pacific Islander

White

Two or more races

Prefer not to respond

What is your child's ethnicity? *

Hispanic or Latino

Not Hispanic or Latino

Prefer not to respond

Does your child have any allergies or need accommodations that we should know about? If so, please tell us below.

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