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Nanny Room Registration
Nanny Room Registration
The maximum number of form submissions has been reached. This form is currently not available.
Parent must be present on site, but in case of emergency it is necessary that we have general information about your child, as requested below on the permission form.
I request that my child(ren) be accepted in the nanny (babysitting) program, located at/in St. Vincent Church Nursery and/or Life Center Red Room during the Families Living Faith parent sessions, or in the St. Vincent School Parish Hall for the Faith First Sacramental Prep Communities.
I Agree
Please select this field.
I grant permission for the administration of First Aid by the people in charge of the St. Vincent Nanny Ministry (staff and volunteers), as their judgement deems advisable, and for staff to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature. This permission applies to my children listed below on this form. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contact the parent/guardian of the child. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery if deemed necessary for my child.
I Agree
Please select this field.
Number of children you are registered for the nanny room
REQUIRED
Please fill out this field.
Please enter valid data.
Name of Mother
Please enter valid data.
Mom Cell
Maximum 20 characters
Please enter a phone number.
Mom Email
REQUIRED
Please fill out this field.
Please enter an email address.
Name of Father
Please enter valid data.
Dad Cell
Maximum 20 characters
Please enter a phone number.
Dad Email
REQUIRED
Please fill out this field.
Please enter an email address.
Child(ren) Lives With:
None
Both Parents
Mom
Dad
Joint Custody
Other
Address of Child(ren) Residence
Please enter valid data.
City
REQUIRED
Please fill out this field.
Please enter valid data.
State
REQUIRED
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Please fill out this field.
Zip
REQUIRED
Please fill out this field.
Please enter a zip code.
Student 1
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Date of Birth
REQUIRED
Please fill out this field.
Please enter a date.
Age
Please enter valid data.
Sex
REQUIRED
(Select One)
Male
Female
Please fill out this field.
Allergies/Special Needs
Please enter valid data.
Any necessary care instructions
Please enter valid data.
Student 2
First Name
Please enter valid data.
Last Name
Please enter valid data.
Date of Birth
Please enter a date.
Age
Please enter valid data.
Sex
None
Male
Female
Allergies/Special Needs
Please enter valid data.
Any necessary care instructions
Please enter valid data.
Student 3
First Name
Please enter valid data.
Last Name
Please enter valid data.
Date of Birth
Please enter a date.
Age
Please enter valid data.
Sex
None
Male
Female
Allergies/Special Needs
Please enter valid data.
Any necessary care instructions
Please enter valid data.
Name & Grades of Siblings in the FFF Program
REQUIRED
Please fill out this field.
Please enter valid data.
For which time/day are you requesting nanny ministry:
Sunday FFF 3:00-4:30
Wednesday FFF 6:00-7:30 PM
Sacramental Preparation (Grades 1 & 2)
Faith First Communities (Grade 1)
If you know someone who would like to volunteer in the nanny ministry please complete the information below. This is a great opportunity for middle school and high school service hours!
Name of potential volunteer:
Please enter valid data.
Volunteer capacity:
Adult Nanny
Substitute Nanny
Jr. High/High School Aide
Potential volunteer contact info:
Please enter valid data.
Submit
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