Email
*
Phone #
(###)
###
####
Parent/Guardian(s) Legal Name(s)
First Name
Last Name
Child's Full and Preferred Name
Child's Birth Date
*
MM
DD
YYYY
Registering for...
*
Your child must be the age you are registering for before Sept 1st of the school year.
Non-refundable Registration Fee of $50 can be paid via check or cash to the offices at First Baptist Church of Clinton (Registration is not complete until the fee is paid in full.)
Gender
*
Male
Female
Primary Home Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Secondary Home Address (if needed)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Who does the child live with?
*
Please list the names and ages of other children in the family
Does your family attend a local church? If so, where?
Any serious illnesses, accidents, allergies or other concerns we should be aware of?
*
BEST CONTACT INFORMATION DURING SESSION 8-11 (NAME AND PHONE NUMBER)
EMERGENCY CONTACT IF PARENT CAN'T BE REACHED (NAME, RELATIONSHIP TO CHILD, PHONE NUMBER AND/OR CELL PHONE) *
NAME AND PHONE NUMBER OF PHYSICIAN TO BE CONTACTED IN CASE OF ILLNESS OR EMERGENCY
I (we) the undersigned, authorize the First Baptist Church Preschool Staff, in the event of an emergency, to take our child to the nearest hospital to render emergency treatment if necessary. (Typed Parent/Guardian Signature and date indicates a YES response)
I (we) give permission for registered child to attend field trips during the school year. I (we) understand that I (we) will be notified when field trips are to take place and where children will be going. (Typed Parent/Guardian Signature and date indicates a YES response)
I (we) agree that First Baptist Church of Clinton may use photographs/videos of my child for such purposes as publicity, illustration, advertising and web content, such as the church website and social media. (Typed Parent/Guardian Signature and date indicates a YES response)
