Trinity Episcopal Church - Fredericksburg,VA: Home: Church Nursery Care Registration Form

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Church Nursery Care Registration Form

2010 -2011 Church Nursery Care Registration Form
Confidential - not for publication or distribution

* Required

Errors

Child's Full Name *

Birth Date *

Address Line 1 *

Address Line 2

City *

ZIP Code *

Baptized?

Yes

If yes, date and place of baptism

Parent(s)/Guardian(s) Names: *

Address Line 1

Address Line 2

City

ZIP Code

Email Address

Home Phone Number *
( ) - ext.

Cell Phone Number
( ) - ext.

Emergency Contact Information: (a parent/guardian is expected to be on church property when their child is being cared for in the Church Nursery, unless under special circumstances.) *

Favorite activities are:

Does not like:

Is allergic to:

Is upset by:

Does Trinity have your permission to use your child's photo on the website or in publications?

Yes

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