Nursery Registration 2023-2024

Child's Name

Child's Birthday

Age

Parent/Guardian Name(s)

Parent/Guardian email

This address will receive a confirmation email

Parent/Guardian Cell Phone

Address (physical address of child/family)

Other Siblings and ages

Description of child's preferred comfort item

I give consent for any photos of my child taken during Sunday School to be used in media and publications such as the Arkive and Ark & Dove website.

YES NO

Emergency Contact Name

Emergency Contact Phone

Please list any allergy, dietary or medical concerns

Please indicate if your child has any special academic needs.

I hereby understand that my child will be supervised and that if a health problem or injury arises, I will be notified. If I cannot be reached by phone, medical treatment and/or hospital care will be administered by competent medical personnel including medication, injections, anesthesia, surgery, or other proper treatments and necessary information may be released for insurance purposes. I verify that all health issues are so noted on this form.

YES

LIABILITY RELEASE: In consideration of Ark and Dove allowing the above child(ren) to participate in Sunday School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Ark and Dove, its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child(ren) while involved in Sunday School. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein.

YES

I acknowledge that the information I provided on this form is accurate, to the best of my knowledge:

YES

Nursery Registration 2023-2024

Description

Please Fix the Following