Conference Registration

Childcare Form

Medical Consent/Child Information Form: Childcare provided for children 6 months to 10 years with drop-off starting at 8:30 and pick-up from 4:30-5:00pm. Parents will be given an identification bracelet at drop –off. Parents wearing the bracelet must be the one to check your child/children out at the end of your last conference session.

Complete One for Each Child

Child Name: *
DOB: *
Allergies:
Medications will need to be administered by the legal guardian.
Medical Concerns:
Cell Phone #:
(Please keep your cell phone on vibrate so that you can be contacted in case of an emergency or if your child has a bowel movement you will need to change them.) In the event of an emergency, we will contact you immediately by cell phone, if medical care is necessary 911 will be dispatched.
Communication Mode: *
Does your child nap?:	No
	Yes
If so what time?:
Please bring 2 snacks, drinks as well as a lunch for your child. Due to allergies make sure that food items do not contain peanut products. It is crucial that you remain onsite and do not leave the building without your child during the conference. Please make sure that your bracelet remains intact until you have checked your child out at the end of the day. Thank You!
Electronic Signature:
Date:

or
Download Childcare Form(.doc)