Pre-Registration Form
Backup Child Care for Students
You must pre-register before you can receive service from Parents in a Pinch. To pre-register, please complete and
submit this form and print a copy for your records. Be aware that it generally takes at least 3 business days for your name
to get into the registration system at Parents in a Pinch.
Pre-registration does not confer any obligation to participate in this program.
First Name: *
Middle Initial: *
Last Name: *
MIT ID: *
MIT Affiliation:
Graduate Student
Undergraduate Student
Department:
Email: *
Work Phone: *
Home or Cell Phone: *
Expected Date of Graduation: *
Terms and Conditions/Disclaimer of Liability As a condition of eligibility, you agree as follows –
MIT makes no representations or warranties regarding the services or caregivers assigned to perform services under this
Program. You are not required to participate in this Program. If you do participate in this Program, you agree to assume
all the possible risks and dangers that may arise from participation in this Program, and release MIT and all of its
affiliates, divisions, departments and other units, committees and groups, and its and their respective governing boards,
officers, directors, principals, trustees, legal representatives, members, owners, employees, volunteers, agents,
administrators, and assigns, (collectively “Releasees”), from any and all claims, demands, suits, judgments, damages,
actions and liabilities of every name and nature whatsoever, whenever occurring, whether known or unknown,
contingent or fixed, at law or in equity, that you may suffer at any time arising from or in connection with the Program,
(collectively “Liabilities”), and you agree to defend, indemnify, and save Releasees harmless from and against any and all
Liabilities.
Agree
Participant Survey
In order to assess interest in this new pilot program, the Graduate Student Council invites you to answer the following
additional questions. Answering these questions is voluntary.
How did you hear about MIT's backup care program, offered through Parents in a Pinch?:
Website
Poster
Email
Friend
Other
When do you anticipate using the service?:
During normal business hours
In the evenings
On the weekends
Other
What do you anticipate will be the main reasons for your using this service?:
Disruption in regular childcare arrangement, for example when a child or caregiver is ill, or during school closings or
vacations
Extra work demands, for example to cover after-hours lab-work, studying for exams, or preparing for presentations
To participate in MIT student activities such as student government meetings
For work related travel, for example when going on a conference-related trip
Other