Nursery Registration

Our Nursery is open to all kids from Infant age 4. Please fill out the registration information below and choose submit or send to the church office at:

Shepherd of the Hills Lutheran Church
4887 Valleydale Road, Birmingham, AL 35242

Child's Name (1st)

Age of First Child

Child's Name (2nd)

Age of Second Child

Child's Name (3rd child)

Age of Third Child

Parent Names (required)

Address

City

State

Daytime Phone Number

Evening Phone Number

Mobile Number

Email Address

Emergency Contact (Other than Parent)

Emergency Contact Phone Number

Relationship to Child

Please list any pertinent health problem, allergies, food concerns, custody issues we need to be aware of