Childcare for 2024 NFB of New Mexico State Convention | National Federation of the Blind of New Mexico

CHILDCARE REGISTRATION FORM

Please submit this form by September 30, 2024 to ensure availability.

Childcare Questionnaire

Contact Information

Guardian 1 Name *

Guardian 1 Cell Phone *

Email (Primary) *

Guardian 2 Name

Guardian 2 Cell Phone

If we can’t get a hold of you, who else can we call?

Alternate Contact Name *

Alternate Contact Cell Phone *

Alternate Contact Relationship *

Please choose the blocks of time when you will need childcare, and tell us the approximate times you plan to drop off and pick up your child.

Friday, October 25 from 8:00 AM - 4:00 PM *

Yes No

Approximate time you plan to drop off your child

Approximate Time you plan to pick upyour child

Saturday, October 26 from 8:00 AM-4:30 PM *

Yes No

Approximate time you plan to drop off your child

Approximate Time you plan to pick upyour child

Saturday, October 26 from 6:45 PM-10:00 PM *

Yes No

Approximate time you plan to drop off your child

Approximate Time you plan to pick upyour child

Sunday, October 27 from 8:45 AM to noon *

Yes No

Approximate time you plan to drop off your child

Approximate Time you plan to pick upyour child

Child 1 Information

Name *

Date of Birth and Age *

Any medical condition(s) we should know about? *

Any Known Allergies *

Activities They Like to Do *

Anything we should watch out for?

Tips and Tricks in Caring for Your Child

Anything extra to add?

Child 2 Information

Name

Date of Birth and Age

Any medical condition(s) we should know about?

Any Known Allergies

Activities They Like To Do

Anything we should watch out for?

Tips and Tricks in Caring for Your Child

Anything extra to add?

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