Hello, SHPC family! Please be aware that you are responsible for reading, understanding and following the SHPC Childcare policies and procedures before requesting care.

* (denotes required field)

Name: *

E-Mail Address: *

Name of Event or Group *

Event or Group Start & End Dates *

Parent phone number (phone available during event) *

Information About Children Requiring Care:

Child's Name *

Child's Age *

Allergies/Notes/Special Conditions

Child 2's Name

Child 2's Age

Child 2: Allergies/Notes/Special Conditions

Child 3's Name

Child 3's Age

Child 3: Allergies/Notes/Special Conditions

Total cost to family: ($2 per child per meeting, not to exceed $5 per family per meeting)

Cost

Comments or message to staff:

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