Student-Parent Symposium Childcare Consent

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Please fill out this consent form if you are a UIC student and would like to use our childcare services for children aged 2-5 during From Surviving to Thriving: Cultivating Possibilities for Parenting Students in Illinois.

The event will take place from 9:00am to 1:00pm, and childcare will be available only during this time.

Submission of this form does not constitute acceptance; we will follow up with you to confirm that your children are eligible for childcare.

If you have any questions about the symposium or this form, please contact us at wlrcsymp@uic.edu.

First & Last Name	Date of Birth (MM/DD/YYYY)	Age	Allergies/Medical Conditions	Special Needs	Toilet Learning (Trained, Still training, Requires assistance)