Summer 2020 Child Care Form

Does your child have any medical concerns, allergies, or physical limitations? Please list all:
Huntington (Countrywood School): What days would you like to register for? ?
Minimum of 3 days required.
Will a third party be covering the cost/partial cost for the program?
Parent/Guardian 1
Emergency Contact 1
Must include someone other than Parent/Guardian
Emergency Contact 2
Must include someone other than Parent/Guardian
Please type your name