Nursery School Enrollment

Please complete the form below to register your child for Nursery School. Please note that there is a $40 registration fee. This fee may be submitted via our Online Giving page, or by cash/check at the church office.

Child Details
Child's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Child's Date of Birth
Date Format: MM slash DD slash YYYY
Parent Details
Parent's E-mail Address
Mother's Name
First Last
Mother's Cell Phone
Father's Name
First Last
Father's Cell Phone
Any other number to reach you
Household Details
Sibling 1 Name
First Last
Sibling 1 Age
Sibling 2 Name
First Last
Sibling 2 Age
Other adults in home besides parents:
Name
First Last
Relationship
Health Details
Primary Care Doctor's Name
Doctor's Phone
List any medical problems or allergies
Emergency Contact Name
The person we should contact if your child gets sick or hurt at school and we cannot reach you at the above numbers.
Emergency Contact Phone
Comments
This field is for validation purposes and should be left unchanged.

Child Details

Parent Details

Household Details

Health Details

ONLINE GIVING