School of Ministry - Childcare Form
You may use this form to pay for any number of dates in the Fall or Spring semesters that you would like to reserve childcare for. You have the option to pay as-needed basis, or the full semester upfront. Each night of childcare will have a cost of $12 per child. It is imperative that we know how many children will be attending so that we can provide quality care!
PHSM Student Name
*
First Name
Last Name
Parent / Guardian Phone Number
*
Please enter a valid phone number.
Parent / Guardian Email
*
(example@example.com) A confirmation email will be sent to the address listed here
How many children will need childcare?
*
Please Select
1
2
3
4
5
What semester are you reserving childcare for?
*
Fall Semester
Spring Semester
Name & age of Child - 1
First and last name
Age
Name & age of Child - 2
First and last name
Age
Name & age of Child - 3
First and last name
Age
Name & age of Child - 4
First and last name
Age
Name & age of Child - 5
First and last name
Age
I need to reserve childcare for the month(s) of _____ in the Fall 2023 Semester
August
September
October
November
December
August - I'd like to reserve childcare for
Tuesday, August 29th
Thursday, August 31st
September - I'd like to reserve childcare for
Tuesday, September 5th
Thursday, September 7th
Tuesday, September 12th
Thursday, September 14th
Tuesday, September 19th
Thursday, September 21st
Tuesday, September 26th
Thursday, September 28th
October - I'd like to reserve childcare for
Tuesday, October 3rd
Tuesday, October 10th
Thursday, October 12th
Tuesday, October 17th
Thursday, October 19th
Tuesday October 31st
November - I'd like to reserve childcare for
Thursday, November 2nd
Tuesday, November 7th
Thursday, November 9th
Tuesday, November 14th
Thursday, November 16th
Tuesday, November 28th
Thursday, November 30th
December - I'd like to reserve childcare for
Tuesday, December 5th
Thursday, December 7th
Tuesday, December 12th
Thursday, December 14th
Tuesday, December 19th
Thursday, December 21st
I need to reserve childcare for the month(s) of ______ in the Spring 2024 semester
January
February
March
April
May
January - I'd like to reserve childcare for
Tuesday, January 9th
Thursday, January 11th
Tuesday, January 16th
Thursday, January 18th
Tuesday, January 23rd
Thursday, January 25th
Tuesday, January 30th
February - I'd like to reserve childcare for
Thursday, February 1st
Tuesday, February 6th
Thursday, February 8th
Tuesday, February 13th
Thursday, February 15th
Tuesday, February 20th
Thursday, February 22nd
Tuesday, February 27th
Thursday, February 29th
March - I'd like to reserve childcare for
Tuesday, March 12th
Thursday, March 14th
Tuesday, March 19th
Thursday, March 21st
Tuesday, March 26th
Thursday, March 28th
April - I'd like to reserve childcare for
Tuesday, April 2nd
Thursday, April 4th
Tuesday, April 9th
Thursday, April 11th
Tuesday, April 16th
Thursday, April 18th
Tuesday, April 23rd
Thursday, April 25th
Tuesday, April 30th
May - I'd like to reserve childcare for
Thursday, May 2nd
Tuesday, May 7th
Thursday, May 9th
Child's allergies or medical conditions we should be aware of
Total childcare needed
Number of Children x Days Needed
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( X )
Childcare, Evening Class - PHSM
Please enter the quantity as the total number of days you've selected to reserve multiplied by the amount of children care is being provided for. (Use the amount listed above for "Total childcare needed")
$
12.00
Total childcare needed
Credit Card
Submit
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