Today’s Date:___________________

First Baptist School Registration

Preschool

 

 

Date of Birth:_________ Place of Birth:________________Current Age____

Child’s Name:________________________________________Male  Female

Home Address:__________________________________________________

City:_________________________________________Zip Code:_________

Days Requested: (Please Circle)     MWF      T TH      5 days

                                 Half    Day                          Full Day

Special Instructions:_____________________________________________

 Allergies:______________________________________________________

Person  responsible for child

Primary Name:___________________________________________________

Address: _______________________________________________-________

City ___________________________________Zip:_____________________

Home Phone:___________________________Cell:_____________________

Employer:_______________________________________________________

Address:________________________________________________________

City:_________________________________Work Phone:________________

Social Security # ____-____- _______ 

Secondary  Name:________________________________________________

Address: _______________________________________________________

City ___________________________________Zip:_____________________

Home Phone:___________________________Cell:_____________________

Employer:_______________________________________________________

Address:________________________________________________________

City:_________________________________Work Phone:________________

Social Security # ____-____- _______

Church Affiliation_________________________________________________

 

 

 

 

 

 

 

 

 

Office Use Only

Registration Fee:_______Check#_________     Handbook   ____Parent Agreement ____     Forms_____

                

Computer_______ Forms and Agreement  Returned________  File________  Blue Card________

Non-Refundable Registration Fee is due upon registration

Office use only

Room #___________       Days________________