Nursery Registration

Parent / Guardian

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Parent / Guardian

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Phone Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Email Please enter an email address.

Emergency Contact in case we can not reach you.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Number of Children REQUIRED Please fill out this field.
Child 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 do not register children under 4 months or over 4 years of age.
  Please fill out this field. Please enter a date.
- Allergies / Special Needs
- Does your child have an EpiPen? REQUIRED Yes No Please fill out this field.
- Photo Release
  
  St. Luke Catholic Church has my permission to use my or my child's photograph publicly to promote the Church. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
- Photo Release REQUIRED I have read and agree to the Photo Release Please fill out this field.
Child 2
- 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 do not register children under 4 months or over 4 years of age.
  Please fill out this field. Please enter a date.
- Allergies / Special Needs
- Does your child have an EpiPen? REQUIRED Yes No Please fill out this field.
- Photo Release
  
  St. Luke Catholic Church has my permission to use my or my child's photograph publicly to promote the Church. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
- Photo Release REQUIRED I have read and agree to the Photo Release Please fill out this field.
Child 3
- 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 do not register children under 4 months or over 4 years of age.
  Please fill out this field. Please enter a date.
- Allergies / Special Needs
- Does your child have an EpiPen? REQUIRED Yes No Please fill out this field.
- Photo Release
  
  St. Luke Catholic Church has my permission to use my or my child's photograph publicly to promote the Church. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
- Photo Release REQUIRED I have read and agree to the Photo Release Please fill out this field.
Child 4
- 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 do not register children under 4 months or over 4 years of age.
  Please fill out this field. Please enter a date.
- Allergies / Special Needs
- Does your child have an EpiPen? REQUIRED Yes No Please fill out this field.
- Photo Release
  
  St. Luke Catholic Church has my permission to use my or my child's photograph publicly to promote the Church. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
- Photo Release REQUIRED I have read and agree to the Photo Release Please fill out this field.

Nursery Registration

Photo Release

Photo Release

Photo Release

Photo Release