Email address
*
Reservation Date
*
-
Month
-
Day
Year
Date Picker Icon
Reservation Start Time
*
Reservation End Time
*
Child Name
*
Child DOB
*
-
Month
-
Day
Year
Date Picker Icon
Child Name
Child DOB
-
Month
-
Day
Year
Date
Parent Name
*
Parent Phone Number
*
Parent Name
Parent Phone
Address
*
Breakfast or Lunch Needed? Additional $5/meal (If bringing own meal, no peanuts please)
*
Yes
No
Allergies/ Additional Information
*
Authorized Pick Ups/Emergency Contacts
*
*Payment for at least one hour of care is required for each child.
*
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Hourly Rate (Ages 1-11 Years Old)
$
12.00
Quantity
0
1
2
3
4
Infant Hourly Rate (Ages 3 Months-12 Months)
$
14.00
Quantity
0
1
2
3
4
Sibling Rate (Ages 1-11 Years Old)
$
6.00
Quantity
0
1
2
3
4
Meal Cost
$
5.00
Quantity
0
1
2
3
4
Back Up Camp Rate (Daily Care AGES 1-4)
$
50.00
Back Up Camp Rate (Daily Care AGES 5-11)
$
40.00
Total
$
0.00
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