Evening Childcare Request Form | St. Luke's United Methodist Church

Childcare Policy*

I have read and agree to the policy

Cost 1. There is no fee to the parents or to the hosting ministry for childcare. Parents must be on campus. Availability 1. Evening Childcare will be open typically Monday or Tuesday and Wednesday nights and Sunday evenings. 2. To be good stewards of the church’s resources, Evening Childcare will only open if 3 or more families are requesting it on the same night. 3. Three days prior to the event, the nursery Coordinator will email the requesting families if childcare will be open OR will call the requesting families if childcare will not be open. 4. You will receive a Childcare Request Receipt immediately upon completing the form. However, childcare will not be provided until you receive a confirmation email with care detail from Nursery Coordinator, Adrian Chandler.

Date needed*

Start time needed

:

End time needed

:

Recurring Event

Is this event recurring?*

Yes
No

End date of event*

Please explain the recurring event*

Parent Location

Event name*

Event location*

Which campus?*

Westheimer
Gethsemane

Child #1

Name

First Last

Age (in months if under 2 years old)

Is the age above in months or years?

Months
Years

Boy or Girl?

Boy
Girl

Does your child have allergies or special needs?

Yes
No

What allergies or special needs does your child have?*

Do you have another child to enter?

Yes
No

Child #2

Name*

First Last

Age (in months if under 2 years old)*

Is the age above in months or years?*

Months
Years

Boy or Girl?*

Boy
Girl

Does your child have allergies or special needs?*

Yes
No

What allergies or special needs does your child have?

Do you have another child to enter?*

Yes
No

Child #3

Name*

First Last

Age (in months if under 2 years old)*

Is the age above in months or years?*

Months
Years

Boy or Girl*

Boy
Girl

Does your child have allergies or special needs?

Yes
No

What special needs does your child have*

Do you have another child to enter?

Yes
No

Child #4

Name*

First Last

Age (in months if under 2 years old)*

Is the age above in months or years?*

Months
Years

Boy or Girl*

Boy
Girl

Does your child have any allergies or special needs?*

Yes
No

What allergies or special needs does your child have?*

Do you have another child to enter?*

Yes
No

child #5

Name

First Last

Age (in months if under 2 years old)*

Is the age above in months or years?*

Months
Years

Boy or Girl?*

Boy
Girl

Does your child have allergies or special needs?*

Yes
No

What allergies or special needs does your child have?*

Parent Information

Parent Name

First Last

Parent Email

Parent Phone