JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
DUMC Nursery Registration
Please fill out the information below to register your child for nursery care. This form only needs to be filled out ONCE, not every time the nursery is used. Registration form MUST be completed for each child.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
1. Child's First and Last Name
*
Your answer
1. Child's Preferred Name
*
Your answer
1. Child's Age and Birthdate
*
Your answer
1. Is Child Potty Trained?
*
YES
NO
Do you want to be contacted for diaper changes? Nursery workers will
NOT
do diaper changes if YES is checked off.
*
YES
NO
Parent / Guardian Name
*
Your answer
Parent / Guardian Cell Phone Number
*
Your answer
Parent / Guardian Name
Your answer
Parent / Guardian Cell Phone Number
Your answer
Services you typically attend
9am : Contemporary and Sunday School
10:10: Liturgical
11:11: Word and Worship
Wednesday Lenten Services
Any Allergies?
*
YES
NO
List of Allergies or Other Medical Issues
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
