XO Childcare Registration

Friday, February 14th + Saturday, February 15th | Please fill out this form and click submit.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Please select the number of children that will be attending and how many days they will be attending. If you have any questions or have more than 5 children attending with you, please contact our office at (386)-257-4622.

Payment

1 CHILD 1 DAY ($5.00) 1 CHILD 2 DAYS ($10.00) 2 CHILDREN 1 DAY ($10.00) 2 CHILDCARE 2 DAYS ($20.00) 3 CHILDREN 1 DAY ($15.00) 3 CHILDREN 2 DAYS ($30.00) 4 CHILDREN 1 DAY ($20.00) 4 CHILDREN 2 DAYS ($40.00) 5 CHILDREN 1 DAY ($25.00) 5 CHILDREN 2 DAYS ($50.00)

Amount

If applicable, please list any allergies your children have:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Friday, February 14th + Saturday, February 15th

Please fill out this form and click submit.

Please Fix the Following

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