CHILD CARE REGISTRATION

CHILD CARE REQUEST FORM

We are pleased to offer on-site child care at no cost for children with the 22q11.2 deletion syndrome and their siblings during conference sessions. Please complete, print, and submit the form below with your conference registration if you will require child care at the conference.

PRIMARY CONTACT INFORMATION:

Name of parent
Phone
E-mail

CHILDREN REQUIRING CARE:

NAME(S):

AGE(S)