GRACE Nursery Registration Form

Child's Name*
First Last
Child's Birthdate
Address
Street Address Address Line 2 City State ZIP Code
Phone Number
Email*
Who is authorized to pick up your child?
(Must be at least 18 years old)
If needed, would you like for our nursery workers to change your child's diaper?*
- Yes
- No
We provide water and crackers during the program. Is that okay?*
- Yes
- No
Any allergies, special needs, or extra information?
Name of Person Filling Out the Form*
First Last
I am giving my consent for Grace Church to use on their website or in print media all photographs in which I/my child appear(s) while involved in the ministries of Grace Church.*
- I Agree
Questions or Comments