2018-2019 Nursery Registration

NURSERY REGISTRATION 2018-2019

(8 weeks up to age 3)

 

 

 

Please list each child enrolling in the Nursery (list age as of September 1, 2018):

 

Child #1: 

______________________________________________________    __________  __________

First                              Middle                              Last                                                             Birthdate                 M/F

 

Age_____________  Medical or other info: ____________________________________

 

Child #2: 

______________________________________________________    __________  __________

First                              Middle                              Last                                                             Birthdate                 M/F

 

Age_____________  Medical or other info: ____________________________________

 

Child #3: 

______________________________________________________    __________  __________

First                              Middle                              Last                                                             Birthdate                 M/F

 

Age_____________  Medical or other info: ____________________________________

 

 

 

PARENT(S) or GUARDIAN NAME(S):

 

_________________   __________________   _________________________    _______        First                                  Middle                                Last                                                      DOB

 

_________________    __________________   _________________________    _______     First                                    Middle                             Last                                                      DOB

 

Primary address: ___________________________________________

___________________________________________

Primary Email address:  _____________________________________

Home ph:  _________________________

Mom Cell ph: ________________________

Dad Cell ph:_______________________

 

Emergency Contact (other than parents):

_____________________________________   _____________________________

Name/Relationship                                                    Ph number