Name:
Address:
Phone Number:
E-mail Address: *
Event Details:
Event Date:
Location:
Type of Event:
Start Time:
End Time:
Estimated Number of Children:
Age Range of Children:

$200.00 service fee (includes set up, break down and clean up of child care site as well as supplies needed for activities and entertainment).

$25.00 per caregiver per hour.

In order for our caregivers to provide the best and safest care possible, we will adhere to the following child to caregiver ratios.
Children 3 years and older, 4:1
Children under 3 years, 2:1

The Washburn Agency requires a minimum guarantee of 4 hours and 2 caregivers per event.

Upon receipt of Event Registration a staff member will contact you within 24 hours. A $200 deposit and signed service agreement is due within 2 weeks of booking.

I agree to the above rates and minimums *
Yes No
Signature *		Date *
* Required