Nursery Registration

Nursery Registration

Child Information Sheet
Parent/Guardian #1's Name*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian #2's Name

First NameLast Name
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Child's Name:*
Child #1
Birthdate*

MonthDayYear
Date
Age
In years (round to approximate age ex 1.5)

Add another Child
Child's Name:
Child #2
Birthdate

MonthDayYear
Date
Age
In years (round to approximate age ex 1.5)

Add another Child
Child's Name:
Child #3
Birthdate

MonthDayYear
Date
Age
In years (round to approximate age ex 1.5)

Add another Child
Child's Name:
Child #4
Birthdate

MonthDayYear
Date
Age
In years (round to approximate age ex 1.5)

Add another Child
Is there anything we should know about your child? (allergies, disabilities, etc.) Special needs or special requests?
Is your child Potty Trained?*

YesNo
May we change your child’s diaper if needed?*

YesNo
Your child must be picked up by an adult
Are there any other adults allowed to pick up your child?*

YesNo
If yes, please include their full name and relationship to your child. *
Health Policy for Children’s Ministry

PARENTS ARE ASKED TO COMPLY WITH THE FOLLOWING GUIDELINES REGARDING ILLNESS:

For the health and safety others, please keep your child home if exhibiting any of the following symptoms in the last 24 hours:
- A known or suspected infectious illness
- A fever of 100.0 F within the past 24 hours
- Nausea, vomiting, diarrhea, or feeling unwell
- Cough, sore throat, croup (except in the case of allergy)
- Colored runny nose
- Common cold
- Contagious skin rash
- Pink eye
- Lice
- Impetigo (infected wounds), boils, ringworm
- Any symptom of childhood disease such as mumps, measles, chicken pox, etc.
- Use of antibiotics for 24 hours or less
Should your child exhibit Covid-like symptoms or test positive for Covid-19 after attending any Children’s Ministry session (i.e. Children’s Chapel, Sunday School, Nursery, etc.), please contact Amy Trias, Family and Children’s Minister at (480) 899-7386 extension: 6 or amy@saintmatthewschurch.org
I acknowledge I have received and read the Health Policy for Children's Ministry*

YesNo
Signature (Custodial Parent or Legal Guardian of Participant)

Clear
Should be Empty:

Nursery Registration

Your child must be picked up by an adult