Grace Nursery 2026-2027 Registration Form
Child Information
Child Name
*
First Name
Last Name
Nickname/Prefered Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Gender
*
Male
Female
Prefer Not To Say
Allergies
Other Health Concerns
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Parent/Guardian Information
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship To Child
*
Please Select
Mother
Father
Aunt
Uncle
Grandparent
Other
Additional Parent
Additional Parent Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship To Child - Additional Parent
*
Please Select
Mother
Father
Aunt
Uncle
Grandparent
Other
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Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship To Child
*
Please Select
Mother
Father
Aunt
Uncle
Grandparent
Other
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Next
Please read the following statements and check each box to show your agreement:
Community Health
*
I acknowledge community health is everyone's responsibility, and I will take reasonable preventative measures to prevent infecting others.
Allergies
*
My child may come into contact with or be served snacks as part of the programing. I have accurately provided info regarding allergies and other health conditions and will update as necessary.
Pick-up
*
I understand my child/children must be picked up by a parent/guardian following Grace’s worship, and that the corresponding colour tag must be presented. Once I pick-up my child/children from Grace’s Nursery, I assume responsibility for him / her/ them.
Emergency Contact
*
I understand that if I am needed while my child/children is/are in Grace’s Nursery I will receive a text or phone call on my cell phone, and will leave my cell phone on and keep it with me while my child / children is/are in Grace’s Nursery.
Signature
*
Date
-
Month
-
Day
Year
Date
Submit
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