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NURSERY REGISTRATION FORM
Child's full name
Your answer
Child's Nickname
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Child's Birthdate
MM
/
DD
/
YYYY
Mother's full Name
Your answer
Father's Full Name
Your answer
Cell Phone
Your answer
Home Phone
Your answer
Email address
the best one to reach you at
Your answer
Address
full mailing address with postal code
Your answer
Child's favorite things
Snacks - fishy crackers, puffs, apple juice, banana
Does your child have any allergies we need to be aware of?
please list below
Your answer
What works best when child is sleepy
Your answer
What works best when child is crying?
Your answer
Is there anything else you would like us to know about your child.
for instance: custody issues or medical issues
Your answer
Are there any traumatic experiential events that would affect the behavior / care of your child?
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Other safe adults the child can go home with.
Your answer
Sibling's Names and Ages
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We encourage parent participation. Are you willing to help in the nursery?
Required
What time frame works best for you
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