Enrollment · Vida Nueva Early Learning Ministry

Tell us about your baby

Welcome! This takes about 8 minutes. Today you save your baby's spot — the rest we'll fine-tune together, in person, when we meet.

Your baby's information is private. Only Vida Nueva staff can see it — we never share it or use it for advertising.

Have these handy:

Your baby's date of birth
2 emergency contacts with phone numbers
Your doctor or pediatrician
Optional: a photo of the immunization record
The schedule you need

First name* Last name* Middle name Preferred name / nickname Date of birth* Babies from 8 weeks to 36 months Gender Home language* Other language Lives with Child's address is the same as Parent 1 Street address City State ZIP code

Program & schedule

Which group and which days do you need?

Program requested* Schedule type*

Days requested*

Preferred start time Preferred end time Desired start date* How did you hear about us? Who referred you? Additional notes

Who cares for your baby?

Start with the first parent or guardian. You can add a second one below.

Parent / Guardian 1

First name* Last name* Relationship* Mobile phone* Work phone Email* Street address* City* State* ZIP code* Employer Employer phone Custodial status Custody / court order notes

Parent / Guardian 2 (optional)

Add a second parent / guardian

First name Last name Relationship Mobile phone Email Street address City State ZIP code Employer

Your support network

Who do we call if we can't reach you, and who may pick up your baby?

Emergency contacts (at least 2)*

Indiana requires at least two emergency contacts. You can add up to five.

#1 First name* Last name* Relationship* Primary phone* Secondary phone

#2 First name* Last name* Relationship* Primary phone* Secondary phone

Add another emergency contact

#3 First name Last name Relationship Primary phone Secondary phone

#4 First name Last name Relationship Primary phone Secondary phone

#5 First name Last name Relationship Primary phone Secondary phone

Authorized pickup persons

People (besides parents) allowed to pick up the child. Up to ten.

#1 First name Last name Relationship Primary phone ID they will show

#2 First name Last name Relationship Primary phone ID they will show

#3 First name Last name Relationship Primary phone ID they will show

#4 First name Last name Relationship Primary phone ID they will show

Health & immunizations

So we can care for your baby well.

Does the child have allergies?

Add allergy details

Allergen Severity Additional notes

Does the child take medications?

Add medication details

Medication Dosage Frequency

Any medical conditions? Medical conditions

Has an IEP or 504 plan? IEP / special needs notes Physician name* Physician phone* Clinic / practice Insurance carrier Policy number Dietary restrictions

Immunizations are up to date

Immunization record (PDF, JPG or PNG, max 5 MB)

Optional today — you can upload a photo now or bring it on the first day.

This is a minor's private file; only staff can see it.

Almost done — just a few permissions

The first six are required. The last two are up to you.

I authorize emergency medical treatment if needed.* I understand the child is released only to authorized persons.* I give permission for field trips.* I authorize applying sunscreen.* I acknowledge receiving the parent handbook.* I acknowledge the payment and late-fee policy.*

I allow photos/video of my child for internal use (the child's portfolio). I allow photos/video of my child for marketing (website, social media).

Save your baby's spot