childcare form - Family Space

Gender *

Name *

First

Last

Address for billing

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

ℹ In case the address for service delivery is different, we shall welcome if you can share it in "Comments" bellow.

Email *

Phone

add your country code (Ex: +33 for French numbers)

Are you ( will you be) tax payer in France? *

Yes
No

ℹ Usefull in case of eligibility to the benefits (see here)

Number of children *

After-school Pick-up

After-school Pick-up

Name of the first child

Birth of first child *

Name of the second child

Birth date second child *

Name of the third child

Birth date third child *

Name of the fourth child

Birth date fourth child *

If you have more than 4 children, please mention this in the comment below.

Schedules

Number of days

Day 1:

Start time:

End time:

Day 2:

Start time:

End time:

Day 3:

Start time:

End time:

Day 4:

Start time:

End time:

Day 5:

Start time:

End time:

If you wish to choose more than 5 days, please mention it in the comment below.

Other options to consider:

Other options

Walking the children out ( in close park)
Outdoor activities ( cinema, restaurant, etc..) for half a day ( 4 hours)
Outdoor activity ( visit, shoping, etc..) in town with the family
Outdoor activities at Disneyland

How did you know about Family Space?

Please tell us more about it

Comments

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry. *

Occasional Childcare

Your quote for an occasional childcare

Schedules

Other options to consider: