NURSERY REGISTRATION FORM

Please complete the online application below to register your child/children for the Pilgrim Rest MBC Nursery Ministry. A member of our staff will contact your shortly.


CHILD INFORMATION

First Name Last Name Gender Date of Birth Allergies/Special Needs Age


ADDITIONAL CHILD

First Name Last Name Gender Date of Birth Allergies/Special Needs Age


PARENT/GUARDIAN INFORMATION

Your Full Name Relationship Cell Phone
Email Home Address

Your Full Name Relationship Cell Phone
Email Home Address

List the names of others authorized to pick up your child/children:


 I authorize that my child's image be photographed, filmed, and be used in video, print, and web presentations.

 I authorize that my email address may be added to the Pilgrim Rest Nursery Mailing List. We will not give your personal information to any third parties. No. I would not like to join the Pilgrim Rest Nursery Mailing List at this time.


HOLD HARMLESS AGREEMENT

I do hereby release, discharge and/or otherwise indemnity and hold harmless Pilgrim Rest Missionary Baptist Church ("PRMBC"), its employees, agents and/or representatives, against any claim as a result of my participation in activities on or about PRMBC or at any function sponsored by PRMBC, including, but specifically not limited to, sports activities at the PRMBC gymnasium from this day forth.

I further agree to protect, indemnify and hold harmless PRMBC against and from any and al loss, cost, damage or expense arising out of or from any accident or other occurrence on or about said premises, causing injury or damage to myself in any manner whatsoever. PRMBC shall not be responsible for and is hereby expressly relieved from all liability by reason of any injury, loss or damage to myself while in, or about the PRMBC or any function sponsored by PRMBC, whether the loss, injury, or damage be to the person or property of said person.

I have read and understand the Policies and Procedures, the Hold Harmless Agreement, and the Nursery Health Policy. I understand that submitting this online application shall be considered as effective and valid as an originalapplication.

E-Signature:

              POLICIES AND PROCEDURES           

Children ages 2 months – 3 years old are welcome. Parents must register their child and complete a hold harmless agreement before the child can attend the nursery.  A parent must be on the church campus at all times while the child is in the nursery.
 
Please do not bring sick children to the Nursery. Your child must be free from colds, fever, diarrhea, vomiting, pinkeye, unexplained rashes, and other ailments for at least 24 hours before coming to the Nursery.
 
The Nursery opens 10 minutes before the Worship Service. Please fill out the information on the sign in sheet completely with your name, child’s name, and special instructions.
 
Please have the following items LABELED and available for the volunteer staff to use: disposable diapers, pacifiers with a clip, a change of clothes, and up to two bottles or “sippy-cups”. All toys should also be labeled. Do not bring medicine of any kind. If your child needs any medication at all, it MUST be kept and administered by the parent.
 
We ask that you feed your child baby/solid food before you come. All bottles or cups must be already mixed and ready to serve.  We will provide animal crackers, cheese crackers, and water.
 
Siblings must be middle-school age or older to pick up any nursery children.
In case of an emergency, the nurse on duty and the parent(s) will be contacted by cell phone.
 
Please be prompt about picking up your child after service. The Nursery will be open for 10 minutes after service ends

                NURSERY HEALTH POLICY             

In order to provide a safe, healthy nursery for all of our nursery children, we ask that you keep your baby or toddler with you any time he/she exhibits the following symptoms:
  • Fever within the previous 24 hours
  • Vomiting and/or diarrhea within the previous 24 hours
  • Any symptoms of childhood diseases such as scarlet fever, measles, mumps, chicken pox, or whooping cough
  • Runny nose with any colored discharge or persistent runny note
  • Any unexplained rash
  • Pink eye and other eye infections
  • Head lice
If your child is being treated with antibiotics, he/she should be on the drug for at least 24 hours before coming back to the Nursery.  
 
To prevent accidental overdose or other problems, nursery staff are NOT PERMITTED under any circumstances to administer medication.  General first aid, such as applying band-aids to minor scrapes is obviously permitted. 
 

                     donations needed                  

Baby wipes (unscented, sensitive skin)
Box of tissue
Disinfectant wipes
Hand sanitizer
Paper towels