Child Registration Form

MagnifiKids Registration

Form must be completed prior to using child care. If you have multiple children, please fill out a registration form for each child. Children must be at least 6 months old .

Child Care Agreement

St. Mary Catholic Church - 1855 St. Mary’s Drive; Montrose, CO 81401

All information will be kept confidential.

* Indicates required field

Child's Name *

First

Last

Date Of Birth (MM/DD/YYYY) *

Name of Mother/Guardian *

First

Last

Mother/Guardian Cell Phone *

Name of Father/Guardian *

First

Last

Father/Guardian Cell Phone *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Name(s) of Person(s) authorized to pick up child: (Must be adults; no teenage siblings will be authorized to pick up child/ren) *

Please specify a PRIMARY contact person with phone number, whom we can TEXT MESSAGE/COMMUNICATE with while the child is in our care, if the child needs YOU (diaper change, cannot soothe, sick, etc) *

First

Last

Phone Number *

Please specify a SECONDARY contact person with phone number, whom we can TEXT MESSAGE/COMMUNICATE with while the child is in our care, if the child needs YOU (diaper change, cannot soothe, sick, etc) *

First

Last

Phone Number *

Helpful Information

Please list any helpful advice for us to better serve your child.

My child has the following special needs regarding sensory, separation anxiety, dietary, allergies, etc.: *

What suggestions do you have for us that will assist your child with any of the above needs? *

Which of the following snacks/drinks is your child allowed to have? *

Cheerios Gold Fish Apple Juice

I understand that child care workers will not change diapers/pull-ups and I will be notified if my child needs to be changed. *

Agree

Initials *

I understand that child care workers are not authorized to administer medication to my child. *

Agree

Initials *

I agree that I will not bring my child in for any Child Care if I reasonably believe that my child is ill or may be contagious. I understand and acknowledge that any child who appears to be ill upon arrival shall not be admitted in Child Care. Nevertheless, I assume full responsibility for the risk to my child that other children who are present in Child Care may be ill and may transmit contagious disease. *

Agree

Initials *

I understand and acknowledge that any medical expenses related to illness or injury to my child while in Child Care are not covered by any insurance program maintained by the parish/organization or the Diocese of Pueblo, or by any of their agents, servants and employees, including any child care workers or volunteers. *

Agree

Initials *

Photographs and Video Release: I give my permission for my child to be included in photographs and videos related to Magnificat Mom and St. Mary Catholic Church. *

Agree Disagree

Initials *

Please sign (type) your name. This will serve as your signature. *

Today's Date (MM/DD/YYYY) *

Additional Comments or Questions *

Disclaimer:

This agreement applies for nursery/child care during church services, Mom's Group, or Small Groups (collectively "Child Care"), which will be performed by employees of the parish, or by volunteers selected and approved by the parish. This Agreement should only be used if the child's parent(s) or guardian(s) will be on the premises.

Revised 2/1/2023

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