PEF Gala Childcare Request 

Happy Hall Schools is thrilled to partner with the Pacifica Educational Foundation to provide free childcare during the PEF Gala on May 16th, from 5:30 PM to 10:30 PM at Sunset Ridge Elementary School!

Please review the following guidelines:

  • Children must be at least 4 years old to attend.
  • Childcare is available only for children of registered PEF Gala guests.
  • Dinner will be provided (pizza and fruit). 
  • List any allergies or dietary restrictions.
  • Happy Hall Schools staff will supervise all childcare.
  • Please fill out one form per child.
Space is limited! Please register by May 8th. Only fill out this form if childcare is definitely needed so we can staff accordingly.

You will receive confirmation of registration on May 11th.

We look forward to providing a fun and safe evening for your little ones while you enjoy the gala! 

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Email *
Student Information
ONLY 1 student per form.
Student First Name
 *
Student Last Name
 *
Student Gender
 *
Student Date of Birth
 *
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/
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Student Grade
 *
Enrollment Status *
My child currently attends Happy Hall Schools (this will not affect enrollment status). 
Dinner *
I would like my child to eat the meal provided by Happy Hall.
Student Allergies
 *
In order to take the necessary precautions, we request that you provide as much detail as possible about your child's allergies.
  • Type of Allergy: Specify the type of allergy/allergies your child has (e.g., food allergies, drug allergies, environmental allergies, etc.). If they have more than one allergy, please list all of them separately.
  • Severity of Allergy: Indicate the severity of each allergy, if possible. For example, does the allergy cause a mild rash, or could it potentially result in a life-threatening reaction like anaphylaxis?
  • Symptoms Experienced: Describe the symptoms your child usually experiences during an allergic reaction. This information will help our staff to quickly recognize and respond to an allergic reaction.
Student Medication
 *
Please provide detailed information about any medication your child may require while participating in our program. This includes medication for allergies, chronic conditions, or any other medical needs.
  • Medication Name: Please provide the name(s) of any medication your child is currently taking.
  • Condition Treated: Please briefly describe what each medication is used for. This will help us understand the purpose of each medication.
  • Administration Instructions: Please provide detailed instructions on how and when the medication should be administered. This should include information on dosage, timing, and any specific steps we should follow.
  • Storage Requirements: Are there any special storage requirements for the medication? For example, does it need to be refrigerated or kept away from sunlight?
  • Expiration Date: If applicable, please provide the expiration date of any medication your child will be bringing to the program.
Student Special Diet
 *
We strive to accommodate the individual dietary needs of all students participating in our care. If your child follows a special diet due to allergies, religious beliefs, personal choice, or a medical condition, please check all that apply below. 
Required
Student Special Needs
 *
If your child has any special needs or accommodations related to a physical, learning, behavioral, or emotional disability, please provide detailed information below.
  • Current Accommodations: Please provide information about the accommodations or modifications currently in place at your child's regular school, if any. This could be anything from an IEP (Individualized Education Program), a 504 plan, or other accommodations.
  • Additional Information: If there are additional details or instructions related to your child's special needs, please provide them here. This might include communication preferences, strategies that have been effective in other settings, ongoing supportive therapies, or considerations to help avoid discomfort or distress.
Parent 1/Guardian 1 Information
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Relationship to Student *
Parent/Guardian Email *
Parent/Guardian Cell Phone
 *
Street Address
 *
City
 *
State
 *
Zip
 *
Parent 2/Guardian 2 Information
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Relationship to Student
Parent/Guardian Email
Parent/Guardian Cell Phone
Authorizations
By submitting this form, you are confirming your request for childcare and agreeing to the guidelines outlined in this Google Form.
Liability Release
 *
I acknowledge that by enrolling my child in childcare for the PEF Gala, I release and hold harmless Happy Hall Schools and its staff from any liability, claims, or damages that may arise during my child's participation, except in cases of gross negligence or willful misconduct.
Required
Medical Care Authorization
 *
In the event of an emergency, I authorize Happy Hall Schools staff to obtain medical care for my child, including treatment by a physician or hospital, if necessary, while my child is in their care. I understand that I will be notified as soon as possible in the event of an emergency.
Required
Contact Information for Questions
You can contact Marina Hamack at marina@happyhall.com or add a message below.
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