Kari Jobe Childcare Registration
*Free Childcare provided for pre-registered children ages 6 weeks-5th Grade from 6:30-10:00 pm
*We will only be providing a light snack
*Space is limited –registration closes midnight July 23.

Guardian's Name:
Your answer
Guardian's Date of Birth:
MM
/
DD
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YYYY
Guardian's email:
Your answer
Guardian's Phone Number:
Your answer
Guardian's Address:
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
Child's name and age (childcare offered for children 6 weeks- kindergarten):
Your answer
List any adults who are authorized to pick up your child (name and phone number):
Your answer
Are there any special needs or allergies we should be aware of? Please list child's name next to allergies and/or special need.
Your answer
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