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CHILD CARE SERVICES ENROLLMENT FORM
(Electronic Version)

The Ecological Society of America
88th Annual Meeting

held jointly with
the International Society for Ecological Monitoring – North American Chapter
Uplands to Lowlands: Coastal Processes in at Time of Global Change


August 3-8, 2003 - Savannah, Georgia  


Please read all of the information below carefully BEFORE completing this Meeting Registration Form.

PLEASE NOTE: The Child Care Services Enrollment Form is available in both electronic and print (hardcopy and downloadable PDF) formats. A Child Profile Form must also be submitted each child enrolled. The completed forms and accompanying payment should be submitted to ESA no later than July 7, 2003. Parent & Child Inc. will accept requests for onsite enrollment on a space available basis ONLY. (For onsite enrollment, forms will be collected and processed at the Onsite Meeting Registration Desk.)

Full payment (by check or money order made payable to the Ecological Society of America or charges to (MasterCard or VISA ONLY) MUST be included with your Child Care Services Enrollment Form regardless of format. The electronic form may be submitted online, but requires payment by credit card. The print form may be submitted to ESA Headquarters by fax to (202) 833-8775 or by mail to ESA/ISEM Annual Meeting Child Care Services, 1707 H Street, NW, Suite 400, Washington DC 20006. If you complete and submit this electronic form, please do NOT submit a print form by mail or fax as duplicate charges may result. Please do NOT mail cash.

 * Section A: Parent/Guardian Contact Information
* Name of Parent(s)/Guardian(s) attending the ESA/ISEM Annual Meeting:
Where will you be staying while in Savannah at the Annual Meeting:†
*Home Address:
*City/State:
Zip/Postal Code:
*Country:
*Home Phone #:
(Example US: (###)###-####x#### ; Intl: +##-####-####-)
Cell Phone #: 
(Example US: (###)###-####x#### ; Intl: +##-####-####-)
Pager #: 
* Email Address:  (username@domain.com,org,edu,gov,net.,) 
 † If you do not know yet, you must provide Parent and Child, Inc. with this information when you drop off your child for his/her first day of care.
 
Section B: CHILD CARE SERVICES OPTIONS
INFANT AND TODDLER CARE
Please provide the following information each child you wish to enroll.
 
Child 1
Child 2
Child 3
Child 4
Child's Name
Child's Date of Birth
Child's Age as of August 1, 2003
Child's Gender (Female or Male) Female Male Female Male Female Male Female Male

Please indicate the number of children you wish to enroll for each date and/or time slot.
 
HALF DAY
FULL DAY
LUNCH
DAY/DATE
AM
(8 AM -NOON)
AFTERNOON
(1:00 PM - 5 PM)
(8 AM-5 PM)
(Extra Fee)
Sunday, August 3
Monday, August 4
Tuesday, August 5
Wednesday, August 6
Thursday, August 7
Friday, August 8
N/A
N/A
N/A


YOUTH SUMMER CAMP: SAVANNAH SUMMERS "JUST FOR KIDS"

Please provide the following information for each child you wish to enroll.
 
Child 1
Child 2
Child 3
Child 4
Child's Name
Child's Date of Birth
Child's Age as of August 1, 2003
Child's Gender (Female or Male) Female Male Female Male Female Male Female Male

Please indicate the number of children you wish to enroll for each day and/or full week of camp.
DAY/DATE
CAMP HOURS
COST
Monday, August 4
8:15 AM to 5 PM
Tuesday, August 5
8:15 AM to 5 PM
Wednesday, August 6
8:15 AM to 5 PM
Thursday, August 7
8:15 AM to 5 PM
Friday, August 8
8:15 AM to NOON
Available with Full Week Only
Full Week
Includes all of the above
 
 * Section C: Payment Information

PLEASE NOTE:
• Credit card payments CANNOT by processed unless the expiration date is provided.
• Meeting Registration Forms received AFTER 5 PM EASTERN DAYLIGHT TIME Thursday, July 24, 2003 will be processed as Onsite registrations.
• A $25 Processing Fee will be assessed for returned checks OR invalid credit cards.
• Requests for refunds will be honored ONLY if received in writing by fax or postmarked no later than Tuesday, July 1, 2003.
• All refunds will be issued AFTER the meeting by October 1, 2003, and are assessed a $25 Processing Fee.

Credit Card Information
*Name as it appears Card:
*Card Type:
*Card Number:

(No Blank Spaces or Dashes )
*Expiration Date: