Nursery Reservations

Parents and Guardians, before completing this form please confirm with your Ministry or Group Coordinator that childcare is available for your event. Mandatory fields below are marked with a red asterisk (*). Reservations and any additional questions can also be addressed by contacting the Nursery Coordinator, Kelli Merchant, via email (preferred) or by phone at 258-2055.

Parent's Information
Parent's First Name* Parent's Last Name*
Phone Number* () -
Email
Number of Children* 1 2 3 4 5 6
 
Program Parent is Attending
Name of Program*
Date of Program*
Time of Program* Check the calendar (opens a new window)
Information for Child #1
Child's First Name* Child's Last Name
Birthdate*  
Special Needs
or Instructions
Allergies
Information for Child #2
Child's First Name* Child's Last Name
Birthdate*  
Special Needs
or Instructions
Allergies
Information for Child #3
Child's First Name* Child's Last Name
Birthdate*  
Special Needs
or Instructions
Allergies
Information for Child #4
Child's First Name* Child's Last Name
Birthdate*  
Special Needs
or Instructions
Allergies
Information for Child #5
Child's First Name* Child's Last Name
Birthdate*  
Special Needs
or Instructions
Allergies
Information for Child #6
Child's First Name* Child's Last Name
Birthdate*  
Special Needs
or Instructions
Allergies
Please click Send Form only once

The information you provide using this on-line form or by other means will be used for the Nursery Coordinator's and Nursery Staff's reference in case of an emergency during your child's stay in the Nursery. In case of an emergency, it will be provided to emergency responders, medical and police personnel on a "need to know" basis. It will not be provided, except as required by law, to any other parties or for any other purposes. This information will be kept on file for the duration of your continuing use of the Nursery but will be destroyed upon your request to the Nursery Coordinator.