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2023-2024 Children's Day Out
Children must be toilet trained (No Pull ups). Cost is $50 per month and limited to 10 children for each class.
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Email
*
Your email
Child's Full Name
*
Your answer
Child's Full Address
*
Your answer
Child's Phone Number
*
Your answer
Child's Gender
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Female
Male
Child's Birthdate
*
MM
/
DD
/
YYYY
Child's Age
*
Your answer
I would like my child to attend:
*
Morning class 8:30 a.m. - 11:00 a.m.
Afternoon class 11:30 a.m. - 2:00 p.m.
Mother's Name
*
Your answer
Mother's Address (if different from child)
Your answer
Mother's Email Address
Your answer
Mother's Phone Number
*
Your answer
Marital Status
Married
Divorced
Separated
Single
Deceased
Other:
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Father's Name
*
Your answer
Father's Address (if different from child)
Your answer
Father's Email Address
Your answer
Father's Phone Number
*
Your answer
Emergency contact (name)
*
Your answer
Emergency contact (phone number)
*
Your answer
Religious Background
Your answer
May we put your child's pictures on the Church's Website and Social Media platforms (Facebook, YouTube, Instagram)
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Yes
No
Please list any allergies or other conditions which may limit activity
*
Your answer
Any other special instructions or things you would like us to know about your child?
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