Nursery Registration

First and Last Name*
First and Last Name
Preferred Name*
Preferred Name
Date of Birth*
Date of Birth
Month
Day
Year
Please list any allergies, dietary restrictions, and medical needs your child has.*
Please list any allergies, dietary restrictions, and medical needs your child has; if none, please write "none" or "N/A".
All are welcome. Does your child have any special needs or learning disabilities we should know about to provide the safest and most comfortable environment possible?
All are welcome. Does your child have any special needs or learning disabilities we should know about to provide the safest and most comfortable environment possible?
What are your child's likes and dislikes?*
What are your child's likes and dislikes?
Is there anything else we should know about your child?
Is there anything else we should know about your child?

Family Information
If you have already filled out family information for one child/youth participant, you do not have to fill this section out again. If you have not yet given us this information, please fill out for at least one youth participant.
Home Address*
Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you members of Saint John's Cathedral? (For information only – all are welcome!)*
Are you members of Saint John's Cathedral? (For information only – all are welcome!)
- Yes
- No
Has your child been baptized?
Has your child been baptized?
- Yes
- No
- No, but I'm interested in baptizing my child
Saint John's requests the right to take photographs/videos of program participants for lawful purposes, including publicity, internal news reporting, and web content.
Saint John's requests the right to take photographs/videos of program participants for lawful purposes, including publicity, internal news reporting, and web content.
- Yes, I give permission to use my child's image on the Saint John's website, in-house promotions, and social media.
- No, I do not give permission to use my child's image anywhere.

Family Information