Date Night Registration Form

Date Night Registration Form

Form ABC-2402
"Book Your Evening: Date Night Registration"
Welcome to A Better Crèche Overnight Childcare Center's Date Night Care! We are delighted to offer you a convenient opportunity to enjoy an evening out while your little ones are in safe and caring hands. Please note that our Date Night Care is exclusively available for children aged 2 years 6 months to 5 years old. Rest assured, our dedicated team is committed to ensuring that your child's experience is filled with fun, comfort, and security. Thank you for entrusting us with your precious ones for a memorable evening!
Child's Name*

First NameLast Name
Child's Age*
Type a question*

MaleFemaleN/A
Allergies/Medical Conditions: [If Applicable]*
IF THERE ARE NO ALLERGIES TYPE N/A
Child's Name

First NameLast Name
Child's Age
Type a question

MaleFemaleN/A
Allergies/Medical Conditions: [If Applicable]
IF THERE ARE NO ALLERGIES TYPE N/A
Child's Name

First NameLast Name
Child's Age
Type a question

MaleFemaleN/A
Allergies/Medical Conditions: [If Applicable]
IF THERE ARE NO ALLERGIES TYPE N/A
Date of Registration*

MonthDayYear
Date
Preferred Drop Off Time: Please select one drop-off time slot for your date night:*

6:30pm - 8:00pm7:00pm - 9:00pm7:30pm - 9:30pm8:00pm - 10:00pm8:30pm - 10:30pm9:00pm - 11:00pm9:30pm - 11:30pm10:00pm - 12:00am
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Safety and Health Check: (Click all that apply)*

Has your child experienced any symptoms of illness (fever, cough, congestion) in the last 24 hoursHas your child been in close contact with anyone diagnosed with COVID-19 in the last 14 daysNone of the above
Is your child currently under any medication or treatment?*

YesNo
If yes, please specify: [Medication/Treatment Details]
Will you be providing dinner or snack options for your child? (Please note: A Better Crèche does NOT provide any dinner options at this time. We do provide the child with a night snack option)*

YesNo
If yes, please specify: [Dinner/Snack Options]
Emergency Contact:

In case of emergency, please provide the following contact information:
Name*

PrefixFirst NameLast Name
Phone Number
Please enter a valid phone number.
Name*

PrefixFirst NameLast Name
Phone Number
Please enter a valid phone number.
Additional Comments or Requests:*
If none type N/A
Medical Consent: In case of emergency, I authorize A Better Crèche staff to seek medical attention for my child.*

YesNo
If you answered "No" to the above question:

We fully understand and respect your decision regarding medical attention for your child in case of an emergency. Please be assured that while we prioritize the safety and well-being of all children in our care, we will strictly adhere to your instructions regarding medical intervention.

In the "My Wishes" space below, it is imperative that you provide detailed information about any specific protocols or alternative arrangements you wish to be followed in the event of an emergency involving your child. Your communication enables us to ensure a safe environment tailored to your child's needs. Should you have any further concerns or require clarification on our procedures, please do not hesitate to reach out to us.
My Wishes:
My wishes as a parent/guardian in regaurds to my child(ren) in case of emergency
Important Notice:

Parents or guardians must pick up their child by the registered time frame. A late pick-up fee of $50.00 will be charged for every minute past midnight, with an additional $5.00 charge for each subsequent minute. Please ensure timely pick-up to avoid additional charges.

A Better Crèche is not responsible for the nutritional value of any dinner or snack provided by parents or guardians.

Date Night Fee: $45.00 (NON-REFUNDABLE)

**Upon completing and submitting your form, you will be directed to our secure payment page for processing. Following successful payment submission, you will receive confirmation of your reservation via email, phone call, and/or text message. In the event that you do not receive a confirmation communication prior to your arrival at the center, please ensure that you have a valid ID and confirmation information of the payment submitted.

Additionally, should you require to cancel or reschedule your reservation, you may do so within 7 days of the original reservation to retain the value of your previously applied reservation. Failure to utilize the reservation within the allotted time frame will necessitate re-registration and payment of the $45.00 fee. We appreciate your understanding and cooperation in adhering to our reservation policies to ensure optimal scheduling for all guests.

Your satisfaction and peace of mind are our utmost priorities, and we look forward to welcoming you and your child for a delightful evening at A Better Crèche Overnight Childcare Center.

By signing and submitting this form, you acknowledge and agree to the terms and conditions outlined above.
Signature*

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Thank you for choosing A Better Crèche Overnight Childcare Center for your date night childcare needs. We're committed to providing you and your child with a worry-free and enjoyable experience.
Date Night Registration
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Date Night Registration Fee(All fees must be paid in order to register. Fees are NON-REFUNDABLE)
$45.00 Quantity (number of children)
Item subtotal:$0.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00
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Date Night Registration Form

"Book Your Evening: Date Night Registration"

Emergency Contact: