BIC Childcare For Activities Parent Name(Required) First Last Phone Number(Required) Phone Number Confirm Phone Number Email(Required) Enter Email Confirm Email Child Name(Required) Child Age(Required)Please enter a number from 1 to 11.Ist Child 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?(Required)HiddenDo_You_Have_Any_Other_Children?(Required) Yes No 2nd_Child_Name(Required) 2nd Child Age(Required)Please enter a number from 1 to 11.Product Name Price: HiddenAny Extra Children? Yes No 3rd Child Name(Required) 3rd Child Age(Required)Please enter a number from 1 to 11.Total Credit Card
