St. Luke Parish

Shoreline, WA

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Childcare for Trivia Night

- Childcare registration
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Please fill out the below registration form to register your child/children for childcare during Trivia Night.
  
  Childcare is included in the purchase of admission for all attending Trivia Night and is available for those children 18 months and older.
  
  Registration is required for children to be able to attend childcare.
  
  Please be aware, you must be on the St. Luke campus in order for your child to be cared for.
  
  Parent Name Please enter valid data.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Emergency Contact Name Please enter valid data.
  
  How is the emergency contact related to you? Please enter valid data.
  
  Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Number of Children REQUIRED Please fill out this field.
  
  Child 1
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Please list any allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  Child 2
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Please list any allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  Child 3
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Please list any allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  Child 4
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Please list any allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  Child 5
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Please list any allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  Child 6
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Please list any allergies: REQUIRED Please fill out this field. Please enter valid data.
  
  By clicking this box, I agree to be on the St. Luke Campus for the entirety of the time while my child(ren) is/are in childcare.
  I Agree Please select this field.
  
  Submit
  
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