Special Events Child Care Registration If you signed up for a Bible Study or special event but haven’t yet made your child care reservation, please do so here. Nursery Care Card - Special Events Thank you for filling this card out as completely as possible, even if you are updating information we already have. Your child's safety and well being are incredibly important to us, and having current information helps us. Which event are you attending?*eg. Women of the Word (morning or evening)Name(s) of Child(ren)*Click the + button to add more rows.NameDate of Birth Mother's Name* First Last Cell Phone*Email Address* Family's Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Child's Known Allergies*Special Instructions*Emergency Contact*Please list two people who can serve as an emergency contact if a parent is not available.NamePhone Emergency Contact*NamePhone Emergency Medical Information*PediatricianPhone NumberPreferred Hospital NameThis field is for validation purposes and should be left unchanged.