Nursery Registration Form

Please fill in the form to help us provide the best care for your child. Please keep it updated as the needs for your child change.

Child's Full Name

Child's Preferred Name

Child's Birthday

Month

Day

Year

Child's Age

Mother's Full Name

Cell Number

Father's Full Name

Cell Number

Address

If We Need You to Return to the Nursery, Should We... (Select One)

Phone Mother's Cell (Keep on Vibrate)

Phone Father's Cell (Keep on Vibrate)

Please Come and Get Me

Do You Wish Us to Change a Diaper?

Change It

Inform Me

Is Your Child Potty Trained?

Yes

No

Needs Help

Baby Feeding Instructions

Can We Give Your Child a Drink?

Yes

No

I Will Provide

Can We Give Your Child a Snack?

Yes

No

I Will Provide

Does You Child Have Any Allergies?

No

Yes

Any Other Instructions or Information?

Signature

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Date

Month

Day

Year