New Child Check In Information
Parents, please list YOUR information below! Make sure to add each child for the children who are here with you! If you have another adult or trusted drop-off/pick-up person, you can add them to your household by adding them below. 
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First Name *
Last Name *
Phone Number *
Email *
Address
Child's Name and Age
Child's Name and Age
Child's Name and Age
Child's Name and Age
Who is allowed to pick up your child other than you?
Any known allergies? *
If so, what is your child allergic to and which child has the allergy?
Is your child/children potty trained?
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If not, would you like for us to change their diaper?
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I agree not to hold Roberta Baptist Church and its nursery volunteers legally or financially liable for any illness, accident or injury to my child that may occur before, during or after any Nursery class. If my child should become ill or be injured and I cannot be contacted immediately, I agree that a nursery volunteer of Roberta Baptist Church may, without liability, act in my stead in consenting to any medical treatment that he or she in good conscience deems to be in the best interest of my child.
 *
I give my permission for any picture taken of my child to be used for promotional purpose.
 *
Please keep your phone on you at all times. If a nursery volunteer needs you, she will contact you by call or text to the number you provided on this form.
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