The First Unitarian Church of Hamilton

Infant-Toddler Room Registration Form

Child’s Last Name: ____________________________________________________________________________

First Name: ___________________________________   Sex: _______  Date of Birth: _____________________

Home Address: __ ________________________________                        

                        ____________________________________________    Home Phone: ____________________

Parent#1  Name:  __________________________________________     Work Phone: ____________________

Parent #2 Name:  __________________________________________     Work Phone: _____________________

Person bringing child to church (if different from above):  _____________________________________________

Names of Siblings registered in the Religious Education Program: _______________________________________

____________________________________________________________________________________________

EMERGENCY CONTACT :

Name:______________________________________________________________________________________

Relationship:______________________________________   Phone Number: ____________________________

Does your child have any allergies? Please be as specific as possible, and also make sure these are posted in the room:

____________________________________________________________________________________________

We serve a morning snack in the Infant-Toddler Room (typically: water, apple juice, crackers, arrowroot cookies, apples, bananas).  Can your child have the snack?                                                                            YES                 NO

If your child becomes fussy during the service, would you like us to come and get you?             YES                 NO                 

For safety reasons and for identification purposes, we photograph each child and post the photo on the wall in the Infant-Toddler Room.  Do we have permission to post your child’s photo?                         YES                NO

By signing below, I agree that I will not leave the building while my child is in the Infant-Toddler Room.   

Name of Parent (please print): ___________________________________________________________________

Parent’s Signature: _________________________________________________  Date: _____________________