• • Child's Full Name *
    
    First
    
    Last
• • Nickname (if applicable)
    
    
• • Birth date *
    
    
• • Home Address *
    
    
• • Home/Main Phone Number *
    
    
    
    
    
    
• • Mother's/Guardian's Name *
    
    First
    
    Last
• • Address (if different)
    
    
• • Cell Phone
    
    
    
    
    
    
• • Work Phone
    
    
    
    
    
    
• • Father's Name
    
    First
    
    Last
• • Address (if different)
    
    
• • Cell Phone
    
    
    
    
    
    
• • Work Phone
    
    
    
    
    
    
• • Email
    
    
• • Siblings Names & Ages
    
    
• • Which Worship Service(s) does your family usually attend?
    8:30 am Traditional
    9:00 am Contemporary
    10:30 Contemporary
    11:00 Traditional
    
• • Other safe adults who can take your child home:
    
    
• • Has your child been in group care before?
    Yes
    No
    
• • If so, was it a positive experience?
    
    
• • What is the best way to calm your child when upset?
    
    
• • Is it okay for your child to play outside?
    Yes
    No
    
• • What words would you use to describe your child?
    
    
• • Please describe your child's favorite activities/games:
    
    
• • Is your child: *
    In diapers
    Potty Training
    Potty Trained
    
• • Is your child on any kind of regular medication? *
    Yes
    No
    
• • If so, please describe in detail
    
    
• • Does your child have any food allergies *
    Yes
    No
    
• • If so, please describe in detail
    
    
• • Does your child have any non-food allergies (for example, bees) *
    Yes
    No
    
• • If so, please describe in detail
    
    
• • Additional Information - Please let us know any additional information (feeding, naps, etc.) that wo
    
    
• • Medical *
    
    In the event that your child(ren) becomes hurt/ill at VBS, we will contact you immediately and also begin to care for them. If that means calling an ambulance, please list your hospital preference above.
• • Photo Release Form *
    Yes
    No
    The Liberty United Methodist Church, if checked yes, will have the permission to use photographs taken of my child(ren) for informational and publicity purposes including, but not limited to, press releases, bulletins, website postings, advertisements or other legitimate purposes for and on behalf of LUMC and it's ministries. I understand that my permission will not allow LUMC to release any information about my child, including, but not limited to, our address or names.
• • LUMC Sonshine Nursery Parent Handbook Receipt (N/A for VBS Early Preschool Rooms)
    Yes
    No
    I acknowledge, by checking yes, that I have received a copy of the LUMC Sonshine Nursery Parent Handbook updated 02/2011.

NOTE: Do Not Alter These Fields: