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Events
PLAN A VISIT
Home
About Us
What We Believe
Meet Our Ministry Staff
The Gospel
Get Connected
Small Groups
Candlelight Prayer and Worship Hour
Children's Ministry
Missions
Contact Us
Sermons
Listen to a Sermon
Sermon Archive (2023-2024)
Events
Events
PLAN A VISIT
Children’s Sunday Program Registration
Adult Responsible for Atendee(s)
*
First Name
Last Name
Relation to Atendee(s)
*
Mom/Step Mom
Father/Step Father
Grandmother
Grandfather
Legal Guardian
Home Phone #
Email Address
*
Would you like to be added to the Children's Ministry Mailing List?
(This information is not shared with any third parties)
Yes
How did you hear about our Children's Program?
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
• Because children love to see their pictures displayed, we may use photographs and videos of your children on bulletin boards, fliers and slide shows. Please let us know if you have any concerns about this. By submitting this registration on behalf of the attendees I hereby consent to have my son/daughter participate in the activities at Windsor Locks Congregational Church. I give my consent and authorization to the adult leadership of WLCC to seek medi-cal treatment for my child in case of an emergency.
Who do you authorize to pick up your child(ren)?
Child's Doctor
First Name
Last Name
Child's Doctor's #
(###)
###
####
Emergency Contact
First Name
Last Name
Emergency Contact's #
(###)
###
####
First Attendee
First Name
Last Name
Sex
Male
Female
Grade
Pre-k through 5th Grade
Birthdate
MM
DD
YYYY
Allergies or Special Needs
Thank you!
Nursery
Child's Name
*
First Name
Last Name
Nickname
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Gender
*
Male
Female
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.
First Name
Last Name
Cellular Phone
*
We ask that you bring your cell phone to church so we may text if you are needed.
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Additional adults authorized to pick up your child from the nursery
My child may have a snack while in the nursery
Yes
No
List All Allergies
Please select the snacks that your child may eat
Cheerios
Animal Crackers
Raisins
Alternate Snack?
I'd prefer to bring an 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.
Yes
No
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
Yes
No
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.
2 Minutes
5 Minutes
10 Minutes
More than 10 minutes
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.
Yes
No
Other Details Or Questions
Questions for the nursery staff:
Additional Instructions for my child:
Virtual Signature
*
Please enter your full name as a signature proxy. Your signature confirms your approval of any content submitted on this form.
First Name
Last Name
Thank you!
