Infants, Toddlers, Twos (Nursery) Registration Form (2025-2026)

Please use this form to register your infants, toddlers, and two-year-olds for the Nursery Program at Centerpoint Community Church.

If you have any questions, please reach out to Carrie Waterhouse (carw80@hotmail.com) or Shanna Crowell (shanna.crowell@centerpointsalem.org).

First Parent/Guardian Name:

Email:

This address will receive a confirmation email

Cell Phone

Home Phone

Address:

Second Parent/Guardian Name:

First Child's Name:

Birthdate:

Any allergies?

Please list anything in this box that will help us better understand your child while we care for them in the nursery. This information will be kept confidential and is only used to help us get to know your child better. (physical disabilities, developmental delays, fears, favorites, IEP, nickname, etc)

Second Child's Name

Birthdate

Any Allergies?

Please list anything in this box that will help us better understand your child while we care for them in nursery. This information will be kept confidential and is only used to help us get to know your child better. (physical disabilities, developmental delays, fears, favorites, IEP, nickname, etc)

Third Child's Name:

Birthdate:

Any Allergies?

Photo Release -I hereby consent to and authorize the use and reproduction by CCC Salem of any and all photographs that have been taken of me and/or my child(ren) for use on our web site, Facebook page, and/or directory. I acknowledge that I have read and understood the terms of this release.

Yes Yes, but please don't use my child(children)'s names No

See you in church!

Description

Please use this form to register for Infants, Toddlers, Twos (Nursery) at Centerpoint Community Church Salem, NH.

Infants, Toddlers, Twos (Nursery) Registration Form (2025-2026)

Description

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