Your Information Your Name Your First Name Your Last Name Your Work Phone Extension Your Department Your Work Title Your Work Email Child's Information Your Child's Name (Or Use "Newborn") Gender Male Female Your Child's Birthday/Due Date Desired Start Date Illini/Primary Parent Information Parent Name Mailing Address City, State, Zip Code Personal Email Address Primary Phone Number Relationship To The Child Secondary Parent Information Secondary Parent Not Applicable Parent Name Mailing Address City, State, Zip Code Personal Email Address Primary Phone Number Relationship To The Child Schedule Information Enter Your Scheduled Pick-up and Drop-off Times (For Regular M-F schedule, select "Monday-Friday". If not, select individual days of the week.) Monday-Friday Monday Tuesday Wednesday Thursday Friday Enter Your Regular M-F Time (Ex: 8a-5p) Enter Your Monday Schedule (Ex: 7a-3p) Enter Your Tuesday Schedule (Ex: 11p-7a) Enter Your Wednesday Schedule (Ex: 7a-3p) Enter Your Thursday Schedule (Ex: 8a-5p) Enter Your Friday Schedule (Ex: 7a-3p) Submit Leave this field blank
