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Registration -
Times: Tuesdays from 9:00am-1:30pm
Location: Worship Center at Crossroads Christian Church Largo - 1645 Seminole Blvd Largo 33778
Coordinator: Dianne Kearney
Contact:
Dianne@crossroadslargo.org
(727)-251-8573
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Child #1 name
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Child #1 Birthdate (mm/dd/year)
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Child #2 Name
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Child #2 Birthdate (mm/dd/year)
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Child #3 Name
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Child #3 Birthdate (mm/dd/year)
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Parent #1 Name
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Phone # (Parent 1)
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Parent #2 Name
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Phone # (Parent 2)
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Parent Email
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Address
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Allergies / medication / special needs
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Emergency Contact Name (only if both parents cannot be reached)
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Emergency Contact Phone #
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Who is allowed to pick up your child? (Excluding parents) Please list full names - we will check ID
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Special Instructions - (child has a special blanket to cuddle when they are sad, potty training)
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Do we have your permission to occasionally post pictures of your child on the Mom's Day Out Facebook page?
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