CHILDCARE REGISTRATION SHEET
OPSEU REGION FOUR EDUCATIONAL - Ottawa - October 27 & 28, 2007

This form must be completed if requesting family/childcare accommodations.

Do you require childcare services at this Regional Educational Hotel?                       YES o                    NO o

If child care is provided at home, please give name of paid caregiver:  __________________________

Child(ren)'s Name(s)

Age

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Health Card #____________________________________________

Does your child have medical needs, allergies, or special care needs?

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                                                         *** PLEASE HAVE YOUR CHILD BRING A FAVOURITE TOY ***

SIGNATURE OF PARENT ________________________________   DATE ___________________________

NAME OF PARENT (please print) ___________________________________________________________

ADDRESS ____________________________________________________________________________

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PHONE NOS:  (RES.#) ___________________________           (BUS.#) ____________________________

(CELL #)_____________________________________

Child care will be available during the hours the Educational is in progress.

Please return this form along with your application form, attendance/advance sheet and personal assistance/needs form, to the OPSEU Brockville Regional Office by September 21, 2007.

Applicants have the option of registering their children in childcare at the Hotel during the Educational or claiming their childcare in the normal fashion on the back of the Expense Claim Form.

Special Note: Please do not register children if you do not wish to bring them with you to the Educational.