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Childcare Registration
Please enter your information below to request childcare. Please note: Request must be received by noon the Monday before requested date.
Name
*
First
Last
Phone
*
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-
###
-
####
Email
*
Choose the date for which you are requesting childcare
Please select
June 5
June 12
June 19
July 3
July 10
July 17
July 24
July 31
Please note that requests must be received by noon the Monday before requested date.
How many children?
*
1st Child's Name
*
First
Last
1st Child's age
*
6weeks-12 mos
1-3 yrs
4-6 yrs
7-12 yrs
2nd Child's Name
*
First
Last
2nd Child's age
*
0-12 mos
1-3 yrs
4-6 yrs
7-12 yrs
13 and older
3rd Child's Name
*
First
Last
3rd Child's age
*
0-12 mos
1-3 yrs
4-6 yrs
7-12 yrs
13 and older
4th Child's Name
*
First
Last
4th Child's age
*
0-12 mos
1-3 yrs
4-6 yrs
7-12 yrs
13 and older
5th Child's Name
*
First
Last
5th Child's age
*
0-12 mos
1-3 yrs
4-6 yrs
7-12 yrs
13 and older
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