Caregiver Café

Thank you for your interest in the Caregiver Cafe'. To ensure we provide enough childcare available, please complete the following information.

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* 1. Name

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* 2. Phone Number

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* 3. email

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* 4. I would like to register for the following Cafe'(s):

Thursday January 19

Thursday February 16

Thursday March 16

Thursday April 20

Thursday May 18

Thursday June 15

Thursday July 20

Thursday August 17

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* 5. Are you a:

Parent

Caregiver (Grandparent, Foster Parent, Family Member)

Childcare Provider

Other (please specify)

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* 6. How many children do you care for?

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* 7. Please list their ages:

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* 8. Please share any ideas or topics you would like to discuss (e.g., potty training, behavior, nap times etc.)

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* 9. I understand all current health and safety protocols will be effect at the cafe

Yes, I understand.