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Time for Tots Drop-in Child Care Registration

Download the Adobe Acrobat version of our required registration forms here:

Please complete and submit the online reservation form below to reserve childcare.


Time for Tots will evaluate and respond to reservation requests
by email or voicemail as soon as possible.

A reservation is not confirmed until a reservation confirmation
is sent to you from Time for Tots.

Parents or Guardians
Parent/Guardian 1
Name:
Address:
City:
State:
Zip:
Email Address:
Work Phone:
Home Phone:
Cell Phone:
   
Parent/Guardian 2
Name:
Address:
City:
State:
Zip:
Email Address:
Work Phone:
Home Phone:
Cell Phone:
   

Child Information
Child 1
Date/Time Childcare is Needed:
Date(s) Childcare is needed   Time Childcare is needed
AT
First Name:
Middle Name:
Last Name:
Age:
Sex:
Preferred Name:
Date of Birth:
Does your child have any special health problems or medical conditions that require special care?
Is your child toilet trained?
Does your child need assistance with: Washing    Eating    Toileting
Food or medical Allergies:
   
Child 2
Date/Time Childcare is Needed:
Date(s) Childcare is needed   Time Childcare is needed
AT
First Name:
Middle Name:
Last Name:
Age:
Sex:
Preferred Name:
Date of Birth:
Does your child have any special health problems or medical conditions that require special care?
Is your child toilet trained?
Does your child need assistance with: Washing    Eating    Toileting
Food or medical Allergies:
   
Child 3
Date/Time Childcare is Needed:
Date(s) Childcare is needed   Time Childcare is needed
AT
First Name:
Middle Name:
Last Name:
Age:
Sex:
Preferred Name:
Date of Birth:
Does your child have any special health problems or medical conditions that require special care?
Is your child toilet trained?
Does your child need assistance with: Washing    Eating    Toileting
Food or medical Allergies:
   
Child 4
Date/Time Childcare is Needed:
Date(s) Childcare is needed   Time Childcare is needed
AT
First Name:
Middle Name:
Last Name:
Age:
Sex:
Preferred Name:
Date of Birth:
Does your child have any special health problems or medical conditions that require special care?
Is your child toilet trained?
Does your child need assistance with: Washing    Eating    Toileting
Food or medical Allergies:
   
Child 5
Date/Time Childcare is Needed:
Date(s) Childcare is needed   Time Childcare is needed
AT
First Name:
Middle Name:
Last Name:
Age:
Sex:
Preferred Name:
Date of Birth:
Does your child have any special health problems or medical conditions that require special care?
Is your child toilet trained?
Does your child need assistance with: Washing    Eating    Toileting
Food or medical Allergies:
   
 

 

Authorization
I represent that I am the parent or legal guardian of each child that on this registration form.
Name:
Date:

   
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