QWOCFF Childcare Registration Form

Please fill out this form completely to register your child for Child Care. If there are any blank sections, you will need to complete them when you check-in. This information is necessary so that we can provide a great Child Care experience.

Please indicate which screening(s) you will attend.

PLEASE NOTE that if you attend more than 1 (one) event, you will need to provide enough food and snacks for your child while they are in Child Care.

Friday, June 9

6:30-10:00pm – Opening Night Screening

Saturday, June 10

3 pm Filmmaker Roundtable
6:30 – 10:00 pm Featured Screening

Sunday, June 11

1:30 – 5:30 pm Centerpiece Screening
5:30 – 8:30 pm Closing Night Screening

PARENT OR GUARDIAN INFORMATION

First Name *

Last Name *

Cellphone (The phone you will have with you during screenings & events) *

Alternate Phone Number

Email *

Street *

City *

State

Zip *

CHILD INFORMATION

First Name *

Last Name *

Age *

Birth Date

// (MM/dd/yyyy)

PERSONALITY & FAMILY

How would you describe your child’s personality? *

Has your child been in childcare before? *

Yes
No

If yes, how was or is that experience for the child?

And for you?

What time(s) and for how long does your child usually nap? *

Are there any special toys, dolls, blankets, etc. that your child needs to go to sleep? *

What is your child’s disposition upon waking up? *

Clingy
Happy
Groggy
Grouchy
Slow
Weepy
Other

Is there a history of hitting or biting? *

Yes
No

If yes, how would you like it to be dealt with?

Are there any “family” rules we should be aware of? *

HEALTH

Has or does your child have any known health problems? *

Yes
No

If yes, please describe

Does your child have any known allergies? *

Yes
No

If yes, please list allergens

Special instructions in case of an allergic reaction *

Has your child had any recent illnesses? *

Yes
No

Has your child had any of the following communicable diseases? *

Chicken Pox
Measles
Mumps
Other
No

Is your child prone to: *

Upset Stomach
Colds
Seasonal Allergies
Earaches
Headaches
Sore Throats
Nose Bleeds
Other
No

Are there any indications of hearing or vision problems? *

Yes
No

If yes, please describe

Does your child have any physical or mental disabilities? *

Yes
No

If yes, please describe

EMERGENCY CONTACT INFORMATION *other than parent/guardian

First Name *

Last Name *

Best Phone Number *

Relationship to You *

Relationship to Child *

PLEASE BE AWARE

We will ONLY feed your child food that you provide, including snacks.

We want to prevent allergic reactions. We want to ensure that they have the foods and portions that you want them to have.

Please make sure that your child is fed before bringing them to childcare and/or provide food & snacks for them.

We will NOT administer medication to your child.

If your child requires medication, you or someone you authorize will have to administer any medication.

What are your expectations of our childcare program? *

For more information, Email festival@qwocmap.org or call 415-752-0868

Please submit this application form by Thursday, June 8

If you submit before the deadline, you will help us greatly to accommodate your child and your childcare needs.

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