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713-622-5710 | 3471 Westheimer Road | Houston, TX 77027
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Parenting Center Childcare Request
Jacel Dickson
2017-03-28T14:53:20-06:00
Parenting Center Childcare Request Form
Childcare is a ministry of the church and provided at no additional cost. Parents must remain on campus while using childcare. For reservations, please complete the form at least one week in advance of your childcare need. If you need to change or cancel your request after you've submitted this form, please call our office at 713-402-5042.
Childcare Request: Parenting the Love & Logic Way
Which dates will you need childcare? (requests are not guaranteed until confirmed by our staff).
Dates Needed
*
Session 1: Sept. 20 | 4-5:30 p.m.
Session 2: Sept. 30 | 4-5:30 p.m.
Session 3: Oct. 7 | 4-5:30 p.m.
Session 4: Oct. 14 | 4-5:30 p.m.
Session 5: Oct. 21 | 4-5:30 p.m.
Session 6: Oct. 28 | 4-5:30 p.m.
Child's Information
Name
*
Child #1 First Name
Child #1 Last Name
Child #1 age (In months if under 2 years of age)
*
Boy or Girl?
*
Boy
Girl
Allergies or Special Needs?
Does your child have allergies or special needs?
More children to add?
*
Yes
No
Child #2
Name
*
Child #2 First Name
Child #2 Last Name
Child #2 age (In months if under 2 years of age)
*
Boy or Girl?
*
Boy
Girl
Allergies or Special Needs?
Does your child have allergies or special needs?
More children to add?
*
Yes
No
Child #3
Name
*
Child #3 First Name
Child #3 Last Name
Child #3 age (In months if under 2 years of age)
*
Boy or Girl?
*
Boy
Girl
Allergies or Special Needs?
Does your child have allergies or special needs?
Parent Information
Parent's Name
*
First Name
Last Name
Parent's Email Address
*
Parent's Phone
*
