Nursery Care Registration
2021 BMA Convention (Ages 0-3)
Please register each child separately
Child's Name
*
First Name
Last Name
Gender
*
Male
Female
Child's Age
*
Parent's Full Name(s)
*
Mother's Cell Number
*
-
Area Code
Phone Number
Father's Cell Number
*
-
Area Code
Phone Number
Other Cell Number (optional)
-
Area Code
Phone Number
Your E-mail Address
*
Please indicate which sessions you are requesting Nursery Care for your child
*
Friday PM 6:45-8:45
Saturday AM 8:45-11:30
Saturday PM 1:30-3:15
Saturday PM 6:45-8:45
Does your child have any allergies?
*
Yes
No
If yes, please specify
Is your child on any medications?
*
Yes
No
If yes, please specify
Diet
*
Breast Milk
Formula
Solid Food
If on solid food, is your child allowed a snack? (Teddy Grahams, Goldfish crackers, Cheerios, etc.?)
Yes
No
Any special dietary needs or restrictions?
*
Yes
No
If yes, please specify
What activities does your child enjoy?
Anything else we should know?
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