Church Nursery Registration Form

Collects the information needed to register a child under age 5 for the church nursery, including contact details and allergies.

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Child's Name

First Name

Last Name

Date of Birth

Age

Name

First Name

Last Name

Phone Number

Email

Address

Street Address

City

State / Province

ZIP / Postal Code

1. Please select the preferred bottle option.

Formula Breast milk No bottle needed

2. Is your child allowed to have snacks?

Yes No

3. What are the favorite activities of your child?

4. What annoys your child at most?

5. Is your child allergic to anything?

Yes No

Please specify what your child is allergic to.

Please provide two trustees who can be contacted in case of emergency.

First Trustee Name

First Name

Last Name

Phone Number

Second Trustee Name

First Name

Last Name

Phone Number

Parent/Guardian Signature

Sign here

Signature Date

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