2019 Childcare Registration Form

Childcare is provided for infants and children up to age 11 only.

How many children will you need care for?*

Parent 1 Name*

Parent 2 Name

(*Please keep your phone on vibrate during sessions)

Cell Phone Number*

Home Phone Number

Email*

Home Address

Church Selection:*

*Important: You are welcome to provide your own snacks and/or lunch for your child.

Specific Food Allergies (if applicable):

Specify special needs for child/ren (if any)

Will your child nap during the time he/she is in childcare? (Give time and special instructions)*

THURSDAY, October 17th (Childcare will open at 8:00 a.m, and 15 minutes before each of the following events.)

Indicate event/s child care needed

Advanced Leadership Sessions (8:30 AM- 9:30 AM)
Opening General Session (10:00AM - 12:00PM)
Lunch Break (12:00PM - 1:30PM)
Workshops I (1:30PM - 3:00PM)
Snacks with Exhibitors (3:00 PM - 3:30 PM)
Workshops II (3:30 PM - 5:00 PM)
General Session II (7:00 PM - 8:00 PM)

*Note: Childcare closed during dinner.

FRIDAY, October 18 (Childcare will open at 8:30 a.m., and 15 minutes before each of the following events.)

Indicate event/s child care needed

Business Breakfast (8:00 AM - 10:00 AM)
Workshops III (8:30 AM - 10:00 AM)
General Session III (10:00 AM - 12:30 PM)

NOTE: Please pick up your child promptly after each event.
You may be asked to present identification at the time of pick up.

Contact information: 970 South Village Oaks Drive, Suite 101 Covina, CA 97124
Michele Chapman at [email protected], or call 626.915.7641 ext. 1

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