Beacon Auction Childcare Registration
Event Date: Saturday, November 2
Event Time: 6 - 9 pm
Address for Free Childcare: Bill and Marsha Owens' house, 2071 N. Rain Tree Rd, Flagstaff
Questions about Childcare or the Event? Contact Roz Clark at 380-6502 or RozRich41@gmail.com
Parent or Guardian Name *
Phone Number *
Email address *
Child #1 Name *
Child #1 Date of Birth *
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Child #1 Allergies or Dietary Restrictions
Child #2 Name
Child #2 Date of Birth
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Child #2 Allergies or Dietary Restrictions
Child #3 Name
Child #3 Date of Birth
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Child #3 Allergies or Dietary Restrictions
Additional Children (Name and Date of Birth)
Additional Allergies or Dietary Restrictions
I agree to allow Beacon appointed childcare providers to provide childcare for listed children in accordance with Beacon policy for the auction event on Saturday, November 2, 2019 *
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