Ridley Park Presbyterian Church Nursery School - Information Sheet
Child's Last Name, First Name *
Smith, William (Billy)
Your answer
Child's Date of Birth *
MM/DD/YYYY
Your answer
Class My Child Will Be Attending *
Child's Gender *
Address Line 1 *
Street address, P.O. Box
Your answer
Address Line 2
Apartment, Suite, Unit, Building, Floor, etc.
Your answer
City, State & Zip Code *
(example: Ridley Park, PA 19078)
Your answer
Parent/Guardian Name; Phone Number(s) *
First & Last Name; (C) XXX-XXX-XXXX; (W) XXX-XXX-XXXX; (H) XXX-XXX-XXXX
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Name; Phone Number(s)
First & Last Name; (C) XXX-XXX-XXXX; (W) XXX-XXX-XXXX; (H) XXX-XXX-XXXX
Your answer
Is this person authorized to pick up your child?
Parent/Guardian Email Address
Your answer
With whom does your child live? *
Your answer
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