Childcare for World Youth Day Event

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Please fill out the following form for EACH child you will be registering for childcare for the day. This will help us meet the needs of every child! Thank you for your cooperation and understanding.

**A child who appears ill upon arrival shall not be admitted. Please plan accordingly.**

Parent's First Name: *

Parent's Last Name:

Phone Number *

Email Address *

Child's First Name: *

Child's Last Name: *

Child's Age: (We will not be hosting children under the age of 2 and over the age of 12. Thank you for understanding!) *

Does your child have any allergies? If so, please list them below. *

Does your child have any medical needs? If so, please list them below. *

Are there any restrictions on normal physical activities? If yes, please specify: *

Does your child have any dietary restrictions? If so, please list them below. *

What is your child’s current sleep & nap schedule? If none, then please list that.
*

Is your child potty-trained? *

Yes

Name of person authorized to pick up your child: *

Phone Number of person authorized to pick up your child: *

In case of an emergency, please list another reliable contact person. *

Phone Number of Emergency Contact *

Relationship to Child (Emergency Contact) *

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