Name: 

  Address:

  City:    State:        Zip:     

  Email:     Phone:
 

Check below if you are registering for a Day or Evening Class (We will ONLY have the evening class if there is enough interest.  The day/time for the evening class has not yet been decided):

                                                    DAY     EVENING 

  Please make a Selection I will need child care I will NOT need child care   Do you or do you not need childcare?

(Please Note:  Childcare is available for pre-school aged children only.  Any parent who uses this childcare may be called on to help with the children during one of the sessions, if we do not have enough volunteers.  If so, the video will be made available so you won't get behind.)    

Name(s) of Child or Children

you will need childcare for:        Age 

   make a selection Birth to 6 months 6 months to 1 year between 1 and 2 years old between 2 and 3 years old between 3 and 4 years old between 4 and 5 years old between 5 and 6 years old

   make a selection Birth to 6 months 6 months to 1 year between 1 and 2 years old between 2 and 3 years old between 3 and 4 years old between 4 and 5 years old between 5 and 6 years old

   make a selection Birth to 6 months 6 months to 1 year between 1 and 2 years old between 2 and 3 years old between 3 and 4 years old between 4 and 5 years old between 5 and 6 years old

Have the children listed above been in childcare at BVBC previously? 

 Yes     No 

Do any of the children listed above have allergies or medical conditions that their caregivers will need to be aware of?   (If yes, we will contact you for further information)

 Yes     No 

Please indicate below if you will be willing to serve for one session in the childcare area?  

 Yes     No     Contact me regarding this