Interest Form Childcare Needed- SSEC

Supporting Every Child: Sensory Strategies for Every Caregiver
Please complete this brief interest form to help us plan for attendance and staffing needs. Your response helps us prepare for the event and is not a formal registration—no additional registration or confirmation is required to attend.

Date:

Thursday, September 17th

Time:

6 - 7:30pm

Location:

Achievement Center of LECOM Health

4950 W 23rd St. Suite #100

Erie, PA. 16506

Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Will any other adult be attending class with you?
How many children do you anticipate needing childcare for during the workshop?
What are the ages of the children who would need childcare? Please list the age of each child (for example: 8 months, 2 years, 5 years).
How did you hear about us?

Other
Do you have additional notes/questions?
Should be Empty: