Church nursery parent information sheet
A one-page safety and contact form nursery staff need before a child is left in their care — not a legal waiver, and not a lengthy registration packet, just the handful of facts staff need if a parent isn't in the room.
When to use it
This is the moment a sheet is non-negotiable. Staff don't yet know this child's allergies, who is allowed to pick them up, or who to call if something happens — the sheet is the only record they have until the family becomes a regular.
Check-in software goes down, tablets lose charge, and guest wifi fails during the exact ten minutes before service starts. A printed sheet in the room is the fallback that works when the system doesn't.
Most new nurseries either use nothing, or copy a scanned form from another church that doesn't match their own room layout or state's basic childcare recommendations. Start with a sheet built for exactly this purpose.
Church Nursery Parent & Guardian Information Sheet
CHURCH NURSERY PARENT & GUARDIAN INFORMATION SHEET
CHILD INFORMATION
Child's Full Name: [Child's Name]
Date of Birth: [MM/DD/YYYY]
Age: [Age]
Today's Date: [Date]
Room / Class: [Nursery Room or Age Group]
PARENT / GUARDIAN (staying on campus during service)
Name: [Parent/Guardian Name]
Relationship to Child: [Parent / Guardian / Other]
Cell Phone: [Phone Number]
Seat Location Today: [Section, row, or "will have phone on"]
EMERGENCY CONTACT (if parent/guardian cannot be reached)
Name: [Emergency Contact Name]
Relationship to Child: [Relationship]
Phone: [Phone Number]
ALLERGIES & MEDICAL NOTES
Allergies: [List all allergies, or "None known"]
Medications on site: [Medication, dose, time — or "None"]
Medical conditions: [Asthma, seizures, diabetes, etc., or "None known"]
Special instructions: [Anything nursery staff should know before drop-off]
AUTHORIZED PICKUP
Only the parent/guardian above, or the people listed below, may pick up
this child. Staff may ask for photo ID from anyone they don't recognize.
1. [Name] — [Relationship] — [Phone]
2. [Name] — [Relationship] — [Phone]
3. [Name] — [Relationship] — [Phone]
CONSENT
[ ] I authorize nursery staff to contact emergency medical services if needed.
[ ] I authorize staff to apply diaper cream / sunscreen if I have provided
and labeled it.
[ ] I have reviewed the allergy and medical information above and confirm
it is accurate as of today.
Parent/Guardian Signature: _______________________ Date: __________
The parent information sheet as a print-ready PDF — free, no email required.
What to put in it
- Child's full name, date of birth, and today's date, so the sheet can't be mixed up with a sibling.
- The parent or guardian's name, relationship to the child, and a cell number they'll actually have on them during service.
- A seat location or "phone on and reachable" note, so staff know where to send someone if needed.
- A separate emergency contact for when the parent can't be reached — a grandparent or family friend on campus.
- Allergies and medical conditions, written even when the answer is "none known," not left blank.
- Any medication the child needs during the service, with dose and timing, and who is authorized to give it.
- A named list of who is allowed to pick the child up — not just "parents only," which fails the moment someone else is asked to grab a sibling.
- A signature line and date, so the sheet reflects information the parent confirmed today, not a stale copy from months ago.
Mistakes that make a nursery drop-off go wrong
An empty box reads as unanswered, not "no allergies." Print "None known" as the default text so staff can tell the difference between a parent who skipped the question and one who confirmed there's nothing to note.
Grandparents, older siblings, and other trusted adults show up to collect kids constantly. Without names on the sheet, staff either block a legitimate pickup or wave through someone they shouldn't — both are the outcome the sheet exists to prevent.
Phone numbers change, new allergies get diagnosed, and pickup lists change as families' situations change. Ask for an updated sheet at the start of each semester or program year, not just once at intake.
The information sheet tells staff who a child is and who to call. It is not a sign-in/sign-out log (a per-service attendance and security-tag record) and it is not an incident report (what happens if something goes wrong). Nurseries that rely on one document for all three end up missing the one they actually need.
FAQ
Who should fill this out — the parent or the church office?
The parent or guardian, in their own handwriting or typed by them, at drop-off or during registration. Staff shouldn't fill in medical or contact information on a family's behalf.
How long should we keep completed sheets?
Follow your own children's ministry safety policy and your insurer's guidance; many churches keep active sheets for the current program year and archive or shred prior years on a schedule. This isn't legal advice — check with your insurance provider or denominational safe-church policy.
Do visiting or drop-in children need one every visit?
Yes, at minimum a quick version on their first visit. Some nurseries pair a one-time information sheet with a lighter weekly sign-in log for return visits — see the free printable forms page for that combination.
Can one sheet cover siblings?
Use one sheet per child. Siblings often have different allergies, ages, and room assignments, and a shared sheet makes it easy to hand the wrong child's medical notes to the wrong room.
Is this sheet enough for a background-check or safe-church policy?
No. This is a per-child safety and contact form, not a volunteer screening or child-protection policy document. Most churches need both: a vetted, trained nursery team, and a current information sheet for every child in the room.