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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:
  
  Address of Child(ren) Residence Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED 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 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
  
  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
  
  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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