Champions Full Day Care Request

Please fill out one form per child, we will be in touch with you to confirm enrollment. Thank you! Por favor complete un formulario por niño y nos comunicaremos con usted para confirmar la inscription. Gracias!

Parent Name

Nombre de los padres

Employer

Empleador

Job Title

Título profesional

Email Address

Correo electronico

Phone Number

Número de teléfono

Child's Name

Nombre del niño

Currently Enrolled in Champions?

¿Está su hijo actualmente inscripción en un programa de Champions?

Yes

Child's Regular School

¿A qué escuela asiste regularmente su hijo?

Consent to release and exchange information

Please check the box to allow exchange of information with the school district Marque la casilla para permitir el intercambio de información con el distrito escolar.

Consent to release and exchange information

Dates for Care

Please check all dates below you would like to request care for. Indique qué días necesitará atención. Monday = Lunes Tuesday = Martes Wednesday = Miércoles Thursday = Jueves Friday = Viernes

Tuesday 5/26

Wednesday 5/27

Thursday 5/28

Friday 5/29

Monday 6/1

Tuesday 6/2

Wednesday 6/3

Thursday 6/4

Friday 6/5

Monday 6/8

Tuesday 6/9

Wednesday 6/10

Thursday 6/11

Friday 6/12

Monday 6/15

Tuesday 6/16

Wednesday 6/17

Thursday 6/18

Friday 6/19

Monday 6/22

Tuesday 6/23

Wednesday 6/24

Thursday 6/25

Friday 6/26

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