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GIVE
MEDIA
SERVE
I’M NEW
I’M NEW
EVENTS
FAMILY LIFE
GIVE
MEDIA
SERVE
Regeneration Childcare Form
Katelyn Bissett
2023-05-24T15:36:10-04:00
Re:generation
Register for Re:generation Childcare
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Parent Name
*
First
Last
Parent Email
*
Parent Phone #
*
*Cell # preferred
Please list the NAME and AGE of all children needing childcare:
*
Do you serve on the re:generation leadership team?
*
yes
no
*Members of the leadership team may begin child drop-off at 5:15pm to accommodate the leaders' meeting.
Childcare staff are paid employees, so donations help us to continue to provide childcare. Please provide a donation if you are able to do so. (Suggested donation of $5/child weekly or $25/child monthly).
Total
$ 0.00
Credit Card - Leave blank if not donating
Card Number
Security Code
Name on Card
Expiration
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