Nursery Registration Form

Child's Name

Nickname

Child's Birthday

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Cellphone Number

Second Parent/Guardian Name

Second Cellphone Number

Second Email

Does your child attend daycare during the week?

Yes, full time. Yes, part time. No.

My child is...

in diapers. working on potty training. potty trained.

Are there any medical needs or information FBC needs to know to keep your child safe? (allergies, medical conditions, etc.)

Are there other people who have permission to pick up your child from the nursery? Please list them.

Agreements

I give (name of child listed above) permission to be in the nursery at First Baptist Church of Lawrence, Kansas and to be under the supervision of FBC staff and volunteers. I understand all reasonable safety precautions will be taken at all times by First Baptist Church staff and volunteers during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold First Baptist Church, its leaders, employees, and volunteer staff liable for any damages, losses, diseases, or injuries incurred by the subject of this form.

I promise to keep my cellphone on and near me in case the nursery needs to contact me and will come when texted.

Digital Signature

Description

Please fill out this form so your child can be in the FBC nursery. Contact Hannah Schenkel, Nursery Coordinator, or Pastor Cristina Adams with any questions.

Nursery Registration Form

Description

Please Fix the Following