Bethune Family Night On-Site Childcare

Bethune Family Night On-Site Childcare
November 17, 2022

Complete this form to register for on-site childcare during the Bethune Family Night performance of Dr. Seuss's How the Grinch Stole Christmas.
Childcare is offered for children ages 2-4. Provided care hours are 6:30pm through the end of the performance.

Student Information

How many kids will you be bringing?*

1
2

Student Name 1*

First Last

Student 1 Date of Birth*

Students must be at least 2 years old

Student Name 2*

First Last

Student 2 Date of Birth*

Students must be at least 2 years old

Parent/Guardian Information

Parent/Guardian Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Add a 2nd Parent/Guardian?

Yes

If yes, an account will be verified/created

2nd Parent/Guardian Information

Parent/Guardian Name*

First Last

Email*

Phone*

Same address as Parent/Guardian #1*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Alternate Contact

(If we are unable to reach a contact listed above)

Alternate Emergency Contact #1*

First Last

Relationship to Student*

Alternate Emergency Contact #1 Phone*

Medical Information

Does the student have special considerations, learning needs, allergies, or medications that we should be aware of?*

Yes
No

(please include any food allergies and/or bee stings)

Please explain:*

Hidden

Demographic Information

Hidden

Which of the following best describes your student?*

Hidden

Tell us more!*

Hidden

If additional information regarding ethnicity feels relevant for your student, feel free to share below. (Ex. Hispanic, Egyptian, Dominican, Somali, Pakistani, etc.)

Hidden

Acknowledge and Agree to Registration Terms

Read & review CTC Education & COVID-19 Policies

Hidden

I understand and accept the Medical Policy

Yes

Hidden

I have read and accept CTC's Education Policies

Yes

Hidden

I have read and accept CTC's Education Policies.*

Yes

Comments

This field is for validation purposes and should be left unchanged.

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