† Please fill out this form and return it to the office at least 2 weeks prior to your program date.
PERSON IN CHARGE OF MAKING CHILDCARE ARRANGEMENTS FOR YOUR GROUP
NAME PHONE EMAIL ADDRESS
DATE OF YOUR EVENT TIME Starting Until
NUMBER OF CHILDREN EXPECTED
LOCATION OF FUNCTION (INCLUDING ROOM NUMBER)
LOCATION TELEPHONE NUMBER
Please Fill out the boxes for the Children that are expected to come.
Parent’s Name(s)
Child’s Name & Age
Comments
Phone Number
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(IF YOU HAVE A CHILD WITH SPECIAL NEEDS OR ALLERGIES, PLEASE INDICATE IN THE FOLLWING BOX
† Thank you for taking the time to complete this form. This is a great help to us and helps us to serve you better.