Nursery Registration Form

St. Bartholomew's Anglican Church

1. Complete one form per child

2. Fill out the form before your first visit to the nursery for the 2020-21 school year. Forms must be completed before a child may be signed in to the nursery

The Nursery program is for children newborn through age 2*. Currently our program is available during the 10am service at St. Bartholomew's Anglican Church.

*Children who turn 3 during the school year may stay in the nursery for the rest of the year. At the beginning of the next school year, they must move up and attend Sunday School.

Child's Name*

Child's Gender*

MaleFemale

Child's Date of Birth (mm/dd/yyyy)*

Date

Mother's Name*

Father's Name*

Address (Street Address, City, State, Zip Code)*

Home Phone #*

Mom Cell #*

Dad's Cell #*

Mom's email address

example@example.com

Dad's email address

example@example.com

Allergies

Any emotional or physical needs of which your child's caregivers must be made aware

Would you be willing to give your time one service per month to volunteer in the nursery?

YesNo

I agree not to hold St. Bartholomew's or any other officer, agent, employee or member thereof legally or financially liable for any illness, accident or injury to my child that may occur before, during or after any Nursery class. I will not leave the grounds of St. Bartholomew's while my child is under Nursery care. If my child should become ill or be injured and I cannot be contacted immediately, I agree that an member of the St. Bartholomew's Nursery team may, without liability, act in my stead in consenting to any medical treatment, including being transported by ambulance to a hospital, that he or she in good conscience deems to be in the best interest of my child. By clicking I agree below, I acknowledge that I have read and understand the Waiver and agree to its provisions.*

I agreeI do not agree

I authorize St. Bartholomew's Anglican Church, its representatives, and employees, to take photographs and video that include images of my child for any lawful purpose in connection with the mission of St. Bartholomew's (publicity, illustrations, advertising, etc 2. to copyright, use, and publish the same in print and/or electronically without the names of my child for any lawful purpose in connection with the mission of St. Bartholomew's (publicity, illustrations, advertising. By clicking on the I agree box below I acknowledge that I have read and understand the Photo Release Agreement and agree to its provisions.*

I agreeI do not agree

By clicking agree below you are stating you have read and understood the Covid 19 Policies and Procedures on our website and understand and commit that it is your responsibility to ensure that all of the measures outlined in our Covid 19 Policies and Procedures for the safely of all who attend St. Bartholomew's Anglican Church Ministry Programs*

I agreeI do not agree

Nursery Registration Form

WAIVER

PHOTO RELEASE AGREEMENT

COVID-19 HEALTH AGREEMENT