Summer Registration

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SUMMER WEDNESDAY MORNING REGISTRATION

Please visit our Summer Morning Study Options page to review studies before registering.

Please note, form answers below will not be saved until you click SUBMIT at bottom of page. Thank you.

STUDY GROUP SELECTION

* Indicates required field

I am interested in *

NEWCOMERS STUDY CURRENT MEMBERS STUDY

PERSONAL INFORMATION

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

CHILD INFORMATION

We are pleased to offer childcare for ages 3 months-6 years for the summer session. Babies in arms are welcome in small group. Please list all your children who will need childcare.

First Child's Name *

FIRST CHILD'S BIRTHDATE *

MM-DD-YYYY

Will your first child need childcare? *

Yes No

If yes, please list allergies and special needs. *

Second Child's Name *

SECOND CHILD'S BIRTHDATE *

MM-DD-YYYY

WILL YOUR SECOND CHILD NEED CHILDCARE? *

YES NO

If yes, please list allergies and special needs. *

Third Child's Name *

THIRD CHILD'S BIRTHDATE *

MM-DD-YYYY

WILL YOUR THIRD CHILD NEED CHILDCARE? *

YES NO

If yes, please list allergies and special needs. *

Fourth Child's Name *

FOURTH CHILD'S BIRTHDATE *

MM-DD-YYYY

WILL YOUR FOURTH CHILD NEED CHILDCARE? *

YES NO

If yes, please list allergies and special needs. *

PLEASE LIST ANY ADDITIONAL CHILDREN NOT INCLUDED ABOVE *

NAME, BIRTHDATE, SCHOOL AND GRADE, IF APPLICABLE, WILL THEY NEED CHILDCARE? IF YES, ALLERGIES AND SPECIAL NEEDS.

PERMISSIONS AND POLICIES

PLEASE CHECK OFF THE FOLLOWING INDICATING YOUR AGREEMENT: *

A limited number of partial scholarships are available to help with childcare fees. If you are interested, please check (info will remain confidential), and a member of the Steering Committee will contact you.

The marketing/promotional materials mentioned below are the weekly e-blasts, event Evites, and other necessary communication from Side By Side - Rochester.

I agree to receiving marketing and promotional materials

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