The Barnes Village Nursery Registration Form

REGISTRATION FORM
Child's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
I would like my child to attend from the following date (please note we are currently registering children to attend from 9-months old):

DayMonthYear
Date
Name of Parent*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Mobile Number*
Please enter a valid phone number.

REGISTRATION FORM