Preschool Registration

PRESCHOOL REGISTRATION

Child's Name *

First

Last

Parent or Guardian's Name *

First

Last

Parent or Guardian Contact E-mail *

Street Address *

City *

State *

Zip *

Parent or Guardian Cell Phone Number

Church Currently Attending *

Child's Age

Child's Birthday

Please confirm child has already completed one year of preschool *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Medical Insurance Company and Policy Number *

Allergy or Other Medical Issue *

Comment or Message

Permission and Disclaimer

Permission Granted *

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