Bethany UMC
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 Nursery Registation & Information Card
2009 - 2010 School Year
This information is required for all Children who use the Nursery
Birth - 2 Years

PARENT INFORMATION

Parent(s) or Legal Gardian(s)

Bethany Member?    

Cell Phone 1 Select One:  Mom   Dad
                        Other  (specify) 
Cell Phone 2

Select One:  Mom   Dad
                        Other  (specify)

 

Street Address
Apt. # 
City 
Zip
Home Phone 
Email Address 

In an Emergency, at specified hours, parent(s) are located:
(State either worship, name of Sunday school class, or other activity & room number if known)

   at  8:15 AM
   at  9:30 AM
   at  11:00 AM
   at  12:30 PM

 

First time visitor?
First time to the Nursery?


CHILD INFORMATION

IMPORTANT: After completing the information below, you must initial and use the "Submit" button at the bottom of the page

CHILD 1

Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information
CHILD 2
Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information
CHILD 3
Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information
CHILD 4
Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information

 
YES, it is okay to use my child's photo on bulletin boards, or in church newsletters, such as Kids News or The Epistle, etc.
NO, it is not okay to use my child's photo on bulletin boards, or in church newsletters, such as Kids News or The Epistle, etc.

IMPORTANT!
By initialing below, I state that all Parent & Child information that has been provided on this form is correct.
Type your initials here to agree:  


Enter the numbers as they
are shown in the image above