Event

Event Name* :
(Small Group, Equipping Class, Celebrate Recovery, Ladies' Bible Study or other)

Select time needed:
Sunday 5-8 p.m.
Tuesday 9-11 a.m.
Other (Please include time and date)

Leader's Name:
(Please list the name of the leader or teacher of your class)

Child's Information:

Full Name*:

Nick Name:

Date of Birth:

Age:
Under one year 1 2 3 4 5 6 7 8 9 10 11

Grade:
Pre-K K 1 2 3 4 5

Gender:
Male
Female

Allergies:

Special needs or other helpful information:

Parent/Guardian Information:

Parent/Guardian Name:

Complete Address:

Home phone number:

Cell phone number:

Email address:

Emergency contact name and phone number:

Please list anyone authorized to pickup your child:

TERMS AND GUIDELINES
To complete your registration you must agree to these terms and conditions.

1. Childcare is for babies through fifth grade students. Tuesday morning childcare is for preschoolers only.
2. There will be two semesters per year, January - May and then August - November. The times that childcare is offered are as follows: Sunday 5-8 p.m. and Tuesday 9-11 a.m.
3. Registration forms must be turned in at least 7 days prior to the date that you will need childcare. A registration form for each child will need to be completed for each semester. Each week you will be required to email tamos@pinelake.org or call by 3 p.m. the Wednesday before to ensure a reservation for the following week. We will also have a sign up sheet at the front desk when you pick your children up, to make your reservation for the following week. We must have a reservation for your child(ren) to assure that we hae enough staff to accommodate them. Children will not be allowed to enroll and be dropped off at the same time. This is for the safety of your children.
4. If there is a last minute childcare need (such as an invited guest) we must have enough advance notice to make accommodations. If accommodations cannot be made in time a childcare reimbursement voucher will be give to cover their out of pocket childcare expenses.
5. There is limited childcare space, so children should only be enrolled if there is a sincere childcare need. Once your child is enrolled, a space is reserved for that child. Staff is scheduled and paid to accommodate those reservations. For those reasons, we ask that parents be good stewards of the childcare program and not enroll your children on an "in case" basis. Any child that does not attend 3 consecutive times will lose their childcare reservation.
6. In consideration for our childcare staff we ask that children be picked up on time. Children must be picked up by 8 p.m. on Sunday evenings and 11 a.m. on Tuesday mornings.
7. To assure that your child's belongings are returned we ask that everything be labeled. This includes bags, bottles, pacifiers, diapers, blankets, bibs, etc. These items can be labeled with masking tape and a permanent marker.
8. As a courtesy to the other parents and children please do not bring you child if they are sick or have been sick within the last 24 hours. This includes fever, diarrhea, vomiting, rash, runny nose (not clear) or any illness that could be contagious.
9. Please call in advance if your child(ren) will be out. You can email tamos@pinelake.org or call 601.829.4507 as soon as you are aware that they will be absent. We understand that emergencies and unforeseen situations arise, however, continual last minute cacellations or absences without a notification with result in the loss of your child's reservation. Childcare is only provided for those that are attending approved church affiliated functions.
10. Please put special needs or instructions for your children in writing and make their teacher aware of them. This will help with the confusion of mulple verbal instructions.
11. Enjoy your time of fellowship with the peace of mind that your child is being loved and learning about God's love in a safe environment.

*If you agree initial here

If you have any problems or questions please contact Tracy Amos, Childcare Director at tamos@pinelake.org or 601.829.4507.

* — required information.