Nursery Child Info Form

Parent Email(Required)

Parent Phone Number(Required)

Child's Birthdate(Required)

Please list all the days your child will attend the nursery.(Required)

Does your child have any known allergies? If yes, please include an explanation.(Required)

Does your child have any known medical concerns? If yes, please include an explanation.(Required)

Emergency Contact #1(Required)

Please list name, relationship, and phone number.

Emergency Contact #2(Required)

Please list name, relationship, and phone number.

Please list anyone who IS ALLOWED to pick up your child from the nursery. If their name is not on the list, they can not pick up your child.(Required)

Is there anything else that you think might be helpful for us to know?

Infant Questions

Does your baby have a lovey? If yes, please describe.(Required)

Does your baby have a paci? If yes, please describe.(Required)

Are there any special instructions for diaper changes?(Required)

Please describe your baby's sleeping patterns/daytime nap routines.(Required)

Do you just put them down and let them cry it out? If yes, how long do you let them cry?

Are there any special instructions for feeding your child?(Required)

1-2 Year Room

Has your child been in any type of structured setting? (ex. Sunday School, Mother’s Morning Out, Story Time, Kindermusik) If yes, please list:(Required)

Does your child have a lovey? If yes, please describe.(Required)

Does your child have a paci? If yes, please describe.(Required)

Are there any special instructions for diaper changes?(Required)

Please describe your child's daytime nap routines.(Required)

Are there any special instructions for feeding your child?(Required)

List 5 words to describe your child and their personality:(Required)

My child is great at:(Required)

My child needs extra help with:(Required)

Toddler Questions

Does your child wear diapers? If so, any special instructions?(Required)

Is your child potty training? If so, any special instructions?(Required)

Has your child been in any type of structured setting? (ex. Sunday School, Mother’s Morning Out, Story Time, Kindermusik) If yes, please list:(Required)

List 5 words to describe your child and their personality:(Required)

My child is great at:(Required)

My child needs extra help with:(Required)

Does your child have a lovey or comfort item? If yes, please describe what it is.(Required)

Are there any food restrictions or special instructions for feeding your child?(Required)