BIC Childcare For Activities Step 1 of 2 50% Parent Name(Required) First Last Phone Number(Required)Email(Required) Enter Email Confirm Email Child Name(Required)Child Age(Required)Please enter a number from 1 to 11.1st Child cost(Required) Price: Does the child have any developmental or cognitive challenges we should be aware of?(Required) Yes No Could you please specify any additional needs or accommodations required for the child?(Required)Do you have any other children?(Required) Yes No 2nd Child Name(Required)2nd Child Name(Required)Please enter a number from 1 to 11.Does the 2nd child have any developmental or cognitive challenges we should be aware of?(Required) Yes No Could you please specify any additional needs or accommodations required for the 2nd child?(Required)2nd Child cost(Required) Price: Do you have any other children?(Required) Yes No 3rd Child Name(Required)3rd Child Age(Required)Please enter a number from 1 to 11.Does the 3rd child have any developmental or cognitive challenges we should be aware of?(Required) Yes No Could you please specify any additional needs or accommodations required for the 3rd child?(Required)3rd child cost(Required) Price: Total Credit Card(Required)Card Details Cardholder Name
