Chelsea Area Mutual Aid Child Care
Chelsea Area Mutual Aid in partnership with St. Paul's United Church of Christ is offering free child care for children between the ages of 2 and 16 during City Council and School Board meetings from 6:30PM-9:00PM Monday evenings. All care givers are CPR/First Aid certified with completed background checks. Please complete the following form (one submission per child, per day) at one week ahead of the next City Council or School Board Meeting to reserve your spot.
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's Email
*
example@example.com
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Name
*
First Name
Last Name
Child's Age
*
Date of Meeting
*
Please Select
November 16 (School Board)
November 23 (City Council)
December 7 (School Board + City Council)
December 14 (City Council)
January 11 (School Board)
January 25 (School Board)
Have you used this service before? If not, you will need to complete a few additional questions.
*
Yes
No
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Intake Form
Please complete the following information for our records.
Please list any allergies your child has (if none, write 'none')
*
Anyone picking up your child (including you) will be required to answer a security code. Please provide this number, phrase, or word below.
*
Child's Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other than you, who has permission to pick up your child? Please include full name, phone number, and relationship.
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship to Child
*
Any other notes or information we should know about your child?
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Submit
Should be Empty: