Nursery Registration (For children up to their 4th birthday)

Name of Child

Primary Address

Mother/Guardian Name

Mother/Guardian Email

This address will receive a confirmation email

Mother/Primary Phone

Father/Guardian Name

Father/Guardian Email

This address will receive a confirmation email

Father/Guardian Phone

Note: the number(s) listed will be used to reach you during the service if your child needs assistance.

Emergency Contact Name

Relationship to child/ren

Emergency Contact Phone

Note: Snacks (animal crackers, gold fish crackers, puffs, etc.) will be offered. We will assume this is OK unless otherwise notified. We also have allergy-friendly options when needed.

Does your child have any allergies? If yes, please list.

Does your child have any medical concerns or safety concerns? If yes, please list.

*When your child turns 2, they will be moved from the nursery to the toddler room when both rooms are available.
*When your child turns 4, we will no longer be able to care for your child in the nursery or toddler room.

We love for parents to volunteer with our childcare program! Volunteers typically serve during one service every 6 weeks. Please note that all children's ministry volunteers have attended Heartland for at least 6 months before starting. This gives us an opportunity to get to know them and for them to get to know Heartland! Thank you for considering!

Yes, I would love to volunteer! Yes, I'm new but I would love to volunteer once the 6 month mark has passed! No, it won't work out for me right now.

The following people (older than 18 years old) are allowed to pick up my child(ren) from the nursery:

Authorized Pick ups:

Description

Please fill out this form and click submit.

Nursery Registration (For children up to their 4th birthday)

Description

Please Fix the Following