Nursery and Toddler Registration Form

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Fields marked with an * are required

Child's Name *

Birthdate *

Parent/Guardian 1 *

Home Phone

Mobile Phone - Parent/Guardian 1 *

Parent/Guardian 2

Mobile Phone - Parent/Guardian 2

Emergency Contact *

Emergency Contact Relationship *

Emergency Contact Phone *

Food Allergies

When child is crying, sooth by

Special needs or concerns

I give my permission to Beacon Baptist Church to keep the information above, in the nursery, for the use of the Nursery Volunteers.

Submission of this form serves as a signature and confirmation that all infromation is correct.