GCC Childcare Form

Great Commission Conference Childcare Form

Please note that this form must be filled out for each child you intend to enroll.
Basic Information
Child's Name*
First Last
Age*
Potty Trained*
- Yes
- No
Grade in School*
Parent/Guardian Information
Parent/Guardian 1*
First Last
Parent/Guardian 1 Phone*
Parent/Guardian 1 Email*
Parent/Guardian 2*
First Last
Parent/Guardian 2 Phone*
Care Instructions
Allergies or Special Medical Concerns*
Bottle Times & Amounts
Other Feeding Instructions
(cereal, baby food, etc.)
Nap Times
Medications
Please include the name, amount, time to be given, and time last given.
Other Special Instructions
Child Pick-up Authorization
The following individuals are authorized to pick up this child in addition to the Parents/Guardians listed above. (MUST HAVE ID BRACELET) An ID bracelet will be given to you when you drop off your child.
Person 1
First Last
Person 1 Relationship to Child/Parents
Person 2
First Last
Person 2 Relationship to Child/Parents
Person 3
First Last
Person 3 Relationship to Child/Parents
Confirmation
Is it ok if we take pictures of your child?*
- Yes
- No
By submitting this form, you are confirming that all information supplied is true and accurate.*
- Yes
- No
Electronic Signature (Enter your full name)*