Nursery Registration Form
Puyallup United Methodist Church
Your Name
*
First Name
Last Name
Child's Legal Name
*
First Name
Last Name
Name Child Likes to be Called
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Age
*
Your Relationship to Child
*
Contact Number During Worship
*
Please enter a valid phone number.
E-mail
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your child allowed to have snacks?
*
Yes
No
Is your child allergic to anything?
*
Yes
No
Please specify what your child is allergic to:
What are your child's favorite activities?
What annoys your child the most?
Person #1 allowed to pick up child
*
Person #1 Phone number
*
Please enter a valid phone number.
Person #2 allowed to pick up child
Person #2 Phone number
Please enter a valid phone number.
Church staff and approved volunteers sometimes take photographs during classroom projects or church events. These may be shared on the church's website and other PUMC publications in print or online. No child's identity will be shared in any way. I, undersigned, give photo release permission:
*
Yes
No
I, undersigned, agree with the following statements:
*
I am the parent/guardian of the child indicated above. If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.
Parent/Guardian Signature
*
Signature Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: