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* 1. Parents' first and last names:

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* 2. Parent's email address:

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* 3. Parent's phone number:

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* 4. Number of parents attending:

Childcare Reservation Information:
Please indicate if child(ren) will need childcare.

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* 5. Name of Child 1:

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* 6. Age of Child 1:

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* 7. Childcare for Child 1?

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* 8. Name of Child 2:

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* 9. Age of Child 2:

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* 10. Childcare for Child 2?

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* 11. Name of Child 3:

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* 12. Age of Child 3:

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* 13. Childcare for Child 3?

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* 14. Any information you would like us to know about your child?

Other Childcare Information: 

  • We have limited space for children ages 10 and under.
  • Drop-ins will not be accepted.
  • Refreshments will be provided.
  • Parents are responsible for changing children's diapers and accompanying the child to the restroom.
  • If a child becomes upset, a childcare person will come to get the parent.
If you have questions, please contact Anita Huffman, ahuffman@parentingnow.org or 541.434.4343.

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