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KLCH Babysitting Clinic 2024 5/18 9a-11a
Please complete this form to register for the KLCH Babysitting Clinic.
Registration is not complete until payment is received.
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Email
*
Your email
Full Name
*
Your answer
Phone Number
*
Your answer
Attendee Name (or Names, if registering more than one participant)
*
Your answer
Emergency Contact Information (ONLY if different than the parent/gaurdian info for the day of the clinic)
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Your answer
Permissions: By accepting, I give permission for the Kansas Learning Center for Health to post my child's information on the babysitting page(s) of the KLCH Website.
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Yes
No
Name & Phone Number(s) to be posted on the KLCH Website (note N/A if you do not want participant listed)
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Your answer
Permissions: By accepting, I give permission for the Kansas Learning Center for Health to use photos of my child taken at the event.
*
Yes
No
Would like to receive our monthly newsletter?
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A copy of your responses will be emailed to the address you provided.
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