Please fill out this form to register for SMILE. All fields in this upper section are required. Parent's Name: E-mail: Address: (optional address line): City, State, Zip: Phone: Child's Name: Birthday: Age as of September 30: Age cut-off for each class is Sept 30. Use this area to provide information on your child (older than 1 year) 1. Does your child have any allergies or restrictions? 2. Does your child need any assistance with routine bathroom procedures? 3. Any general information to know your child better? 4. Is your child in Kindergarten? ---- Yes No Use this area to provide information on your child (younger than 1 year) 1. Does your child usually take a morning nap? ---- Yes No 2. If "Yes", how does he/she sleep? ---- Back Stomach Side 3. Does your child have a? ---- Bottle Pacifier Neither 4. How does your child like to go to sleep? ---- Rocking Just lay down Other PLEASE MARK ANY BABY SUPPLIES YOU BRING. The information on this form is e-mailed to New Danville Mennonite Church.
1. Does your child have any allergies or restrictions? 2. Does your child need any assistance with routine bathroom procedures? 3. Any general information to know your child better? 4. Is your child in Kindergarten? ---- Yes No
1. Does your child usually take a morning nap? ---- Yes No 2. If "Yes", how does he/she sleep? ---- Back Stomach Side 3. Does your child have a? ---- Bottle Pacifier Neither 4. How does your child like to go to sleep? ---- Rocking Just lay down Other PLEASE MARK ANY BABY SUPPLIES YOU BRING.
PLEASE MARK ANY BABY SUPPLIES YOU BRING.
The information on this form is e-mailed to New Danville Mennonite Church.
