Nursery Registration Form 2018-2019

We need a new form for each family every program year (July-June). If you have any questions, please contact Becky at children@hslckirkland.org.

Adult 1 Name *
Adult 1 Name
Adult 1 Cell Phone *
Adult 1 Cell Phone
Adult 2 Name *
Adult 2 Name
Adult 2 Cell Phone
Adult 2 Cell Phone
Family Address
Family Address
Member?
Child 1 Name *
Child 1 Name
Child 1 Birthdate *
Child 1 Birthdate
Child 1 Baptism Date
Child 1 Baptism Date
Information is kept confidential.
Child 2 Name
Child 2 Name
Child 2 Birthdate
Child 2 Birthdate
Child 2 Baptism Date
Child 2 Baptism Date
Information is kept confidential
Please write your name below.