Housing Justice Convergence: Child Care Registration & Release Form

Housing Justice Convergence: Child Care Registration & Release Form
Childcare at the Housing Justice Convergence
We’re committed to making the Housing Justice Convergence (HJC) accessible to parents and caregivers by providing free onsite childcare at Concordia University’s JMSB building.
- Location: While the main convergence will take place on the 9th floor, childcare will be hosted in the Zen Den on the 5th floor.
- Supervision: Experienced volunteers will provide care in a safe and welcoming space.
- Activities: Children will have access to toys, games, and activities generously provided by the CSU Daycare.
If you require childcare, we encourage you to sign up with this form in advance to help us plan accordingly. Drop-ins will be accommodated as space allows.
Parent/Legal Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Emergency Contact

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.
How many Children will be joining us?

123
Child's Name

First NameLast Name
Child's Age
Child's Name

First NameLast Name
Child's Age
Child's Name

First NameLast Name
Child's Age
Please indicate which blocks you would like to sign up for child care?

Friday, 12:00pm - 5:00pmSaturday, 9:00am - 12:00pmSaturday, 1:00pm - 5:00pmOther
Please write down any allergies or medical conditions of your child.
Please indicate any special accomidations/needs that would support your child:
Parent/Legal Guardian Signature

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Date

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Date
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