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2018-2019 Joy! Nursery Registration
For Children under age 3 years old (by Sept. 1, 2018)
*** One Child per Registration Form***
Last Name: *
Your answer
Fist Name: *
Your answer
Parent's Last Name: *
Your answer
Parent's First Name(s): *
Your answer
Parent email address: *
Your answer
Address: *
Your answer
City, State: *
Your answer
Zip Code: *
Your answer
Phone: *
Your answer
Emergency Contact Name: *
Your answer
Emergency Contact Phone Number: *
Your answer
Child's Birth Date: *
Your answer
Gender:
Your answer
Medical Conditions/Allergies/Special Needs:
Your answer
Normal service you attend on Sunday *
Can we feed your child pretzels, goldfish or crackers while in the nursery? *
Required
Can we give your child 100% apple juice while in the nursery? *
Does your child use a sippy cup? *
Is your child potty trained? *
If your child has a stinky or very wet diaper may we change it? *
Favorite Toys/Pacifier/Movies etc…something that would help distract him/her if they start to cry… Describe:
Your answer
Can anyone else pick up your child besides who dropped the child off?
If yes, who has permission?
Your answer
Any other helpful information we should know?
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