JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
UTMC Nursery REGISTRATION
Required for Nursery Attendance
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Male or Female
*
Choose
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian Name
*
Your answer
Other Parent/Guardian Name(s)
*
Your answer
Phone Number
*
Your answer
E-mail Address
*
Your answer
Please List any Allergies
Your answer
Can we take pictures of your child for use within the church and social media?
Yes
No
Clear selection
Please list any health conditions your child has
Your answer
**UTMC teachers and helpers are not to give any medication. If your child needs medication, the parent or guardian must be present and administer it.**
I am interested in helping in the Nursery
Yes
No
Clear selection
I Will Sign Paper Waiver
*
Yes
Parent Name Filling Out the Form (In place of signature)
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Upper Thames Missionary Church.
Report Abuse
Forms
