Kids Church
First Name
*
Middle Name
Preferred Name
Last Name
*
Gender
*
Male
Female
Mobile Number
*
Demographics
*
Adults
Youth
Children
Nursery
Preschool
School Age
Mailing Address
*
Mailing Address Line 2
Mailing City
*
Mailing State
*
Mailing Zip Code
*
School Grade
*
-- None --
Nursery/Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Special Needs Child
*
Yes
No
Allergies
Is your child potty trained?
*
Yes
No
Are you comfortable with a Nursery Worker changing the child's diaper?
*
Yes
No
Are there any special toilet considerations you wish to make known? (ex. they are independent or may require some assistance)
Are there any special feeding considerations? (ex. breast feeding, formula, frequency, amount)
What forms of consoling does your child respond best to?
Is there any additional information that would help us care for your child?
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