PPO Meeting Childcare Request Form
Please submit this request if you will be attending the upcoming PPO meeting and are requesting child care by LJHA students during the meeting. This will be offered based on availability and it is first come first serve. If you have a change in attendance, please notify us so we can make your spot available for other families. We ask for sign up greater than 48 hours in advance. Additionally, if we have no prior requests for childcare, we will dismiss the LJHA volunteer.
Important Information:
- General meetings are once a month and anticipated to be between 1-1.5 hours in length.- If a child needs a diaper addressed or to use the bathroom, volunteers are to bring the child to the meeting room so parent(s)/gaurdian(s) can address the need. - If there is an injury of any type, the volunteers are asked to report to the parents immediately.
Parent's Full Name
*
First Name
Last Name
Parent's Email Address
*
example@example.com
Parent's Phone Number
*
Please enter a valid phone number.
Child's Name
*
Child's Age
*
Please Select
1-5 months
6-11 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Other
Child's Name
Child's Age
Please Select
1-5 months
6-11 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Other
Child's Name
Child's Age
Please Select
1-5 months
6-11 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Other
Child's Name
Child's Age
Please Select
1-5 months
6-11 months
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Other
Additional Concerns or Special Instructions
Submit Request
Should be Empty: