NURSERY REGISTRATION

Mother Name *
Mother Name
Mother Cell Phone
Mother Cell Phone
Father Name
Father Name
Father Cell Phone
Father Cell Phone
Address
Address
Child 1 Name
Child 1 Name
Date of Birth
Date of Birth
Child 2 Name
Child 2 Name
Child 2 Date of Birth
Child 2 Date of Birth
Child 3 Name
Child 3 Name
Child 3 Date of Birth
Child 3 Date of Birth
Child 4 Name
Child 4 Name
Child 4 Date of Birth
Child 4 Date of Birth
Child 5 Name
Child 5 Name
Child 5 Date of Birth
Child 5 Date of Birth
The nursery depends on parent volunteers throughout the year. Please check the box below if you would like to be added to our volunteer email list.
I agree not to hold the Sts. Simon and Jude Catholic Parish, or any other officer, agent, employee or member thereof, legally or financially liable for any illness, accident or injury to my child that may occur before, during or after any nursery program. If I should leave the grounds of Sts. Simon and Jude Parish while my child is on the grounds, I will notify my child’s caregiver in advance and provide the caregiver with an emergency telephone number, at which I can be contacted. If my child should become ill or be injured and I cannot be contacted immediately, I agree that a caregiver, staff or member of the Sts. Simon and Jude Parish 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 hereby give permission for Sts. Simon and Jude Catholic Parish, to use my child’s photograph (without their name) in Parish publications, on the Parish website and in news releases in regard to any Parish-sponsored activity. By signing below, I acknowledge that I have read and understand both the Waiver Release and Media & Photo Release and agree to all provisions. I also agree to abide by the rules and guidelines in the Tiny Catholics Handbook.