SBC IN-PERSON CAFE REGISTRATION FORM

In-Person Café Participation Form (San Bernardino County)
Thank you for your interest in CCRC's Parent Cafés. Please complete the form below to register.
Participant Contact Details :
Full Name

First NameLast Name
Phone Number
E-mail
example@example.com
In which city do you live?
Zip Code
Area
Fill Q
{fillQ}

In-Person Café Dates :
Select a single cafe date or explore options for attending a Café series.

In order to allow all interested families to participate in an in-person cafe experience, please only select one date/series per household at a time.

how many infants?
how many toddlers?
how many preschool age?
how many school-age?
how many teens?
What are the names of the children?
If any of the children attending have allergies (food, environmental, etc.) please list them below:
How many children do you need childcare for? (INACTIVE QUESTION)
What are the ages of the children? (INACTIVE QUESTION)

	NUMBER OF CHILDREN REQURING CHILDCARE
INFANT (under 1 yr)
TODDLER (1-2 yrs)
PRESCHOOL-AGE (3-5 yrs)
SCHOOL-AGE (6-12 yrs)
TEEN (13 yrs or older)

In Person CaféAgrements
By signing up for a Café, the participant agrees to do their best to attend and notify the facilitator if they are unable to attend.*

AgreeDisagree
You must be able to agree to this commitment in order to complete registration. Please email RReveryone@ccrcca.org for more information.
By signing up for a Café, the participant understands that CCRC has some wellness protocols in place that to support everyone's wellbeing. Please conduct a personal wellness check prior to attending and if you are not feeling well or have COVID related symptoms, we kindly ask that you rest at home and join us another time.*

AgreeDisagree
You must be able to agree to this commitment in order to complete the registration. Please email RReveryone@ccrcca.org for more information.
By signing up for a Café, the participant affirms that they are a resident of San Bernardino County, within areas served by Child Care Resource Center.*

AgreeDisagree
You must reside in San Bernardino County in order to participate in a CCRC Café. If you need assistance locating your local Resource & Referral agency, please email RReveryone@ccrcca.org
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In-Person Café Participation Form (San Bernardino County)