Bethany UMC
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 Nursery Registation & Information Card
2007 - 2008 School Year
This information is required for all Children who use the Nursery
Birth - 2 Years

PARENT INFORMATION:

Parent(s) or Legal Gardian(s)

 

Bethany Member?    

Street Address    

   Apt. #     

City    

Zip    

Home Phone    

Cell  Phone   

Email Address    

In an Emergency, Parent(s) may be in the following location(s)? (make selections below)
 

Worship Service
Adult Sunday School
Children's Sunday School
Youth Sunday School
Other?

First time visitor?  

CHILD INFORMATION:

IMPORTANT: After completing the information below, you must initial and use the "Submit" button at the bottom of the page

CHILD 1

Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information
CHILD 2
Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information
CHILD 3
Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information
CHILD 4
Preferred First Name and Last Name
Gender
Birthday (mm/dd/yyyy)
Allergies / Special Information

IMPORTANT!
By initialing below, I state that all Parent & Child information that has been provided on this form is correct.
Type your initials here to agree: