Nursery Registration

Child's Name

Child's Gender

Male Female

Age

Child's Date of Birth

Allergy/Medical Info

Parent Names

Parent Phone

Parent Email

This address will receive a confirmation email

Address

Are there custodial issues about which we could be aware? If yes, please explain.

Please provide any special instructions regarding your child

NOTE: BETHANY REQUESTS THAT YOU DO NOT PROVIDE A SNACK FOR YOUR CHILD UNLESS HE/SHE HAS A SPECIAL DIETARY REQUIREMENT

A home-provided snack must meet the following requirements:

- NO nuts of any type
- Only other prepackaged foods with a label stating that the food has not been processed or packaged in a facility where nuts are present or used in processing.

Bethany provides only Cheerios and gluten-free graham crackers in the Nursery and Toddler areas.

Is your child allowed to have Cheerios?

Yes No

Is your child allowed to have gluten-free graham crackers?

Yes No

All personal items such as diaper bags, bottles, sippy cups, etc. should be clearly labeled with the child's name.

Please, be aware that a dated stickers must be presented at pickup time for us to safely release your child.

Please enter your first and last name here as an electronic signature.

Description

Please fill out this form and click submit.

Nursery Registration

Description

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