Nursery Registration

Please fill out this form and click submit.

Child's Name

Parent/Gaurdian Information

Name

Address

Primary Phone

Secondary Phone

Information About Child

Date of Birth

Age

Bottle?

Please select one option.

Yes No

If yes, please provide answers to the following questions: Time of Feeding? Amount of Feeding? Warmed or Cold?

Snack?

Please select one option.

Yes No

If yes, will your child be eating snacks provided by the nursery or will you be providing snacks for your child?

Please select all that apply.

I will provide a snack for my child My child may eat snacks provided in the nursery

Toilet

Please select one option.

My child may use the potty My child wears diapers My child wears pull-ups

Getting to Know Your Child

Favorite activities?

Does NOT like:

Important medical information / Allergies

Has your child ever been in a nursery or daycare?

Please select one option.

Yes No

Is there anything we should know about your child? eg. little Johnny calls his pacifier a

Pick up Privileges

List one or two additional adults who may pick up your child

In Case of Emergency

In the case of an emergency, the primary contact information listed above will be used to relay pertinent information or call for immediate pick up from the nursery. Expectations on a Sunday morning are that Parents/gaurdians will be present on church property. Exceptions are made to this rule for special events outside of regular Sunday mornings.

Emergency Contact Name

Phone

All of the above information is correct to the best of my knowledge.

Signed:

Description

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Nursery Registration

Description

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