ATS Childcare Registration Form 2023-24
Please fill out one form per child.  Childcare drop off is 15 minutes prior to the start time of the events and pick up is to be no later than 15 minutes after your event ends.  All childcare is being held in the Community House this semester.  200 Susanna Way, Wilmore KY, 40390.  Reach out to hannah.carmack@asburyseminary.edu or text 502-303-8478 with any questions.  If you are unable to make it to childcare a certain week, please email or message me to let me know!  More than 2 no shows for registered childcare without notice will result in being removed from the reservation list.  
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Email *
What event or events are you needing childcare for?  Please check all that apply.  
Name of Parents/Guardians *
Child's First and Last Name *
Child's age and birthdate *
Home Address *
Parent/Guardian Cellphone Number *
Emergency Contact: Name and Number *
Does your child have any allergies?  If so, please describe allergy and type of reaction. *
Does your child have any special needs? If so please tell us how best we can serve your child.
Does your child have any comforts?  Or ways we can help if they are upset?
Is this child potty trained?   *
Any additional information for our workers or questions you have?
A copy of your responses will be emailed to the address you provided.
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