Mom's Day Out Fall/Spring Registration Form

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Mom's Day Out Fall/Spring Registration Form

Mom's Day Out Fall 2018-2019 Registration Form

Check the appropriate schedule*

Home Address*

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I understand that a picture ID will be needed if anyone other than the parent picks up the child. Under NO circumstance will the child be allowed to leave with someone whose name not on the list without a note from the parent.*

Does your child and his/her family attend church regularly?*

Has your child ever been involved in a Mom's Day out, nursery school, or daycare before?

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Please answer the following, where applicable.

Is your child

Does your child take a

Does your child sleep on their

Is your child accustomed to being rocked to sleep?

Does your child experience problems with

Please answer the following, where applicable.

Is your child

Does your child like to play outside?

Choose below

FBC MDO has permission to photograph my child to be used in social publications such as: Facebook, MDO publications, church media, etc.