Church Nursery Registration Form

Church Nursery Registration Form
Child's Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Age
Parent/Guardian
Name
First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Getting Familiar With Your Child
1. Please select the preferred bottle option.
When fedPre-PreparedWarmedCold
2. Is your child allowed to have snacks?
YesNo
3. What are the favorite activities of your child?
4. What annoys your child at most?
5. Is your child allergic to anything?
YesNo
Please specify what your child is allergic to.
In Case of Emergency
Please note the names of two people who only may pick up your child from the nursery.
First Trustee Name
First NameLast Name
Phone Number
Please enter a valid phone number.
Second Trustee Name
First NameLast Name
Phone Number
Please enter a valid phone number.
Parent/Guardian Signature
Clear
Signature Date
MonthDayYear
Date
Should be Empty:

Parent/Guardian