Conference creche registration

Bluey and Baloo conference childcare Registration Form
You can sign up for childcare at conference here by completing this form!

Please use this form to pre-register your childcare needs to help us with planning and to secure your spot(s) in advance.

Childcare will be available throughout the conference. During session hours. Full days include morning and afternoons.

Please get in touch if you have any questions, requests or activity ideas.
Name of conference
Child 1
Name

Given / Preferred NameFamily Name
Age when at conference
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list who is authorised to pick up this child
Please list and describe any food or drug allergies, or food restrictions this child has
Does your child have any medical conditions? If so, please list them here
Does your child require any medication? If so, please list these medications here
What days and times are you looking for care?
Do you authorise us to administer the medications listed above?
Child 2
Name

Given / Preferred NameFamily Name
Age when at conference
What days and times are you looking for care?
As Child 1
Please list who is authorised to pick up this child
As Child 1
Address (if different to first child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list and describe any food or drug allergies, or food restrictions this child has
Does your child have any medical conditions? If so, please list them here
Does your child require any medication? If so, please list these medications here
Do you authorise us to administer the medications listed above?
Child 3
Name

Given / Preferred NameFamily Name
Age when at conference
What days and times are you looking for care?
As child 1
Address (if different to first child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list who is authorised to pick up this child
As child 1
Please list and describe any food or drug allergies, or food restrictions this child has
Does your child have any medical conditions? If so, please list them here
Does your child require any medication? If so, please list these medications here
Do you authorise us to administer the medications listed above?
Additional Children

If you wish to register more than 3 children, please use the comments section at the bottom to mention this. We will get back in touch with you to establish your requirements.
Parent/Guardian Information 1
Name

Given / Preferred NameFamily Name
Phone number during the conference

Country CodeArea CodePhone Number
E-mail address during the conference
Parent/Guardian Information 2
Name

Given / Preferred NameFamily Name
Phone number during the conference

Country CodeArea CodePhone Number
Phone number for pre-conference (if different)

Country CodeArea CodePhone Number
E-mail address during the conference
example@example.com
E-mail address for pre-conference (if different)
example@example.com
Address - Same As Child?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact
Name

Given / Preferred NameFamily Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number

Country CodeArea CodePhone Number
Other Infomation
Comments
Please contact Michelle at michelle@blueyandbaloo.co.uk if you require any assistance.

www.blueyandbaloo.co.uk
Heading
This is a fill in the blanks field. Please add appropriate blank fields and text.
Should be Empty:

Bluey and Baloo conference childcare Registration Form

Child 1

Child 2

Child 3

Additional Children

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact

Other Infomation

Heading