Name: Babysitting Clinic
Start: 2024-06-13T09:00:00-05:00
End: 2024-06-13T14:00:00-05:00
Location: The Medical Center-WKU Health Sciences Complex

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Event Title

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Event Venue

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Event Start Date/Time

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Event End Date/Time

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Event Description

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Event Organizer Name

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Event Organizer Phone

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Event Organizer Email

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Event Account Code

Name*

First Last

Phone*

Email*

Please register with a valid email address as this will be our main form of class communication. If there is ever a need to cancel (weather related) or reschedule a class, we will send out an email. Thank you.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How did you learn of the event?*

MCH Website
Social Media (Facebook, Twitter, etc.)
Newspaper
TV

Ticket

Price:

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Credit card information not needed for free events

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Type

Additional Information

Expectant Mother's Name

First Last

Due Date

Dad/Guest's Name

First Last

Date of Birth

Entry A Title

Entry A Art Form

Entry A Price

Entry B Title

Entry B Art Form

Entry B Price

Agreement*

I understand that submission of an entry to this exhibition indicates my agreement with all conditions set forth in the prospectus, as well as my permission to allow The Medical Center to photograph my work for publicity purposes.

T-shirt size preferred

Emergency Contact's Name

First Last

Who should we call in case of an Emergency?

Emergency Contact's Relationship

Emergency Contact's Phone Number

Parent or Guardian Name

First Last

Drop-off/Pick-up Name

First Last

Please list the name of the person who will be responsible for dropping off your child at 9:00 a.m. and picking up your child by 2:00 p.m.

Drop-off/Pick-up Relationship

Relationship of the person responsible for dropping off and picking up your child

Child or Children's Names

You may register up to 4 children.

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Please press "Submit" only once.

There is sometimes a delay in processing your request. If you believe you have submitted a registration and it did not go through, contact the event organizer listed on this page.

Children

Name

Age

Please enter a number from 1 to 18.

Gender

Up to 4 children

Grandparents

Grandparent's Name

Up to 4 grandparents

Comments

This field is for validation purposes and should be left unchanged.

Babysitting Clinic

June 13 @ 9:00 am – 2:00 pm

Registration

Additional Information

Child or Children's Names

Please press "Submit" only once.

The Medical Center-WKU Health Sciences Complex

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Event Navigation

Babysitting Clinic

June 13 @ 9:00 am – 2:00 pm

Registration

Additional Information

Child or Children's Names

Please press "Submit" only once.

The Medical Center-WKU Health Sciences Complex

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Event Navigation