Children’s Church, Sunday School

Adult Responsible for Atendee(s) *
Adult Responsible for Atendee(s)
Would you like to be added to the Children's Ministry Mailing List?
(This information is not shared with any third parties)
Who do you authorize to pick up your child(ren)?
Child's Doctor
Child's Doctor
Child's Doctor's #
Child's Doctor's #
Emergency Contact
Emergency Contact
Emergency Contact's #
Emergency Contact's #
First Attendee
First Attendee
Pre-k through 5th Grade


Child's Name *
Child's Name
Date of Birth *
Date of Birth
1st Parent or Guardian's Name *
1st Parent or Guardian's Name
A parent / guardian is expected to be on church property when their child is being cared for in the church nursery.
Cellular Phone *
Cellular Phone
We ask that you bring your cell phone to church so we may text if you are needed.
Address *
Please select the snacks that your child may eat
Alternate Snack?
Diaper Changing and Potty Help
If needed, I would like the nursery staff to change my child’s diaper *
If you answered (No) we will notify you with a text so you may come and change the diaper.
After using the potty, I would like the nursery staff to assist with wiping *
For the safety of both children and nursery staff; diapers will always be changed in the presence of two nursery workers. If a child needs assistance in the bathroom, the door will be left open while being helped
General Guidelines
• In accordance with our goals for safety we ask that no one enter the nursery except for approved staff, volunteers and parents who are picking up or dropping off a child. We do not allow men to stay in the nursery, so fathers should not linger and socialize in the nursery. • We ask that if a child is having a hard time adjusting that you allow our volunteers the opportunity to soothe and comfort your child in your absence.
Soothing Time *
If within the time you select all efforts have been exhausted we will notify you immediately. • Our staff and volunteers are not permitted to administer any medications. Please make sure that there are no medications in your child’s diaper bag.
Well Baby Policy
We ask that you do not bring your child to the Nursery if any of the following are present • Diarrhea, vomiting or fever within 24 hours • Constant cough • Eye irritation, pink eye • Open wound, questionable rash • Unusual irritability or fatigue
Check In
Children will have this registration form updated each year. When you arrive, you can “sign-in” by putting up your child’s magnet, check to see that all information is up to date, and use the whiteboard to list specific instructions for that week.
Media and Photo Release
I give my permission for WLCC to use my child’s photograph on bulletin boards, website and WLCC publications.
Other Details Or Questions
Virtual Signature *
Virtual Signature
Please enter your full name as a signature proxy. Your signature confirms your approval of any content submitted on this form.