Jolliff United Methodist Church  
Request for Child Care/Nursery

(Please have this form back by Wednesday at noon to request nursery for the following Sunday).

Name: ________________________________________________________________________ 

Cell Phone: ________________________ (Can we send you a text?) ______________________ 

Email Address: _________________________________________________________________ 

Date nursery is needed: _____________________ Number of children: ____________________   

Name of Child/Children: _________________________________________________________ 

______________________________________________________________________________ 

Age of Baby/toddler: ____________________________________________________________ 

Any Special instructions/allergies: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

I understand that by submitting this request there will be a paid attendant in the nursery to watch my child. If something arises that I will not be able to attend I will contact the church Office Manager at (757) 488-2784 or Email: Secretary@JolliffUMC.org


______________________________________________________________________________ 

Signature:  

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