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Drop-In Employee Childcare Questionnaire & Registration Form

  1. Palm Beach Gardens

  2. Drop-In Employee Childcare Questionnaire & Registration Form

  3. This is a drop-in program that does not require a commitment. The purpose of this form is to receive your feedback for childcare. This program is only available for the children of City employees in grades K-8. Children may be dropped off between 7:30am and 6:00pm and only when parents are physically at their workplace. The program will not facilitate E-Learning. Therefore, children will not be permitted to bring any electronics. This information is requested so that we can properly staff our program and offer quality activities.

  4. Employee Parent/Guardian Contact Information

    Contact information for the parent/guardian who is a City employee should be keyed in here.

  5. Other Parent/Guardian Contact Information

  6. Child(ren) Information

  7. Is this child's classes currently planned to be held virtually or in person?*

    Please select one.

  8. Is this child's classes currently planned to be held virtually or in person?

    Please select one.

  9. Is this child's classes currently planned to be held virtually or in person?

    Please select one.

  10. Anticipated Childcare Needs

    We understand that needs may change. In order to ensure proper staffing throughout the program, please email recinfo@pbgfl.com with any updates to your childcare needs.

  11. What time of day do you anticipate utilizing this program?*

    Check all that apply.

  12. Which days do you anticipate utilizing this program?

    Check all that apply.

  13. Thank you for taking the time to complete this form as accurately as possible!

  14. Leave This Blank: