Please fill out the Nursery/Playroom online registration form below or print a pdf copy of the form, fill it out, and return it to our This email address is being protected from spambots. You need JavaScript enabled to view it..

NOTE: If you'd like to register a child in grades K-12, please go HERE.

NURSERY/PLAYROOM ONLINE REGISTRATION FORM

(*)'d items are required.

Parent/Guardian Name(s) (*)

Please enter a valid parent/guardian name
Address (*)

Please enter a valid address.
Home Phone (xxx-xxx-xxxx) (*)

Please enter a home phone number in the format xxx-xxx-xxxx
Cell Phone (xxx-xxx-xxxx)

Please enter a phone number in the format xxx-xxx-xxxx
Email (*)

Please enter a valid email address
Email 2

Please enter a valid email address
Child's Name (*)

Please enter child's name
Date of Birth (*)

Please enter date of birth
Age (*)

Please enter age
Sex (*)

Please enter child's sex
Siblings Names and Ages

Invalid Input
Is your child toilet trained? (*)

Please answer Yes or No
Allergies, concerns, and/or special needs

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I give permission for my child's photos/work to be used in: (*)




Please fill in Publicity Permissions
Add me to the church mailing list (*)

Please choose Yes or No
Additional Comments

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Please enter validation code (*)
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  Give me a new code
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