First Baptist Church Joelton - PATH Preschool 2019-20 Registration

PATH Preschool 2019-20 Registration

FBCJ’s PATH Preschool meets on Monday, Wednesday, and Friday from 9 a.m. - 2 p.m. The program runs from August until May. The 2019-20 session is scheduled to begin on August 19.
Should a class be full, your child will be placed on a waiting list. Enrollment is complete when all forms, immunization record, and registration fee are submitted.
You may use this form to register your child and submit payment electronically. If you will be registering multiple children, please complete a separate form for each child.
Your Email Address	*
Child’s Age as of 8/15/19 *
Child's Full (Given) Name	*
Child's Preferred Name (Nickname)	*
Child's Birthdate (Month, Day and Year)	*
Mother's Name
Mother's Address
Mother's Home Phone
Mother's Cell Phone
Mother's Work Phone
Mother's Employer Address
Mother's Work Hours
Is Mother a member of a church? If yes, what church?
Father's Name
Father's Address (if different from Mother's)
Father's Home Phone (if different from Mother's)
Father's Cell Phone
Father's Work Phone
Father's Employer Address
Father's Work Hours
Is Father a member of a church? If yes, what church?
The following adults are authorized to pick up/transport the above named child. (Please include name, phone numbers, and relationship to the child.)
Has your child ever attended a preschool/daycare/MDO before?
PREFERENCES - You may specify the following preferences, and we will make every attempt to honor your requests, but we cannot guarantee that all requests will be fulfilled.
Are there any specific children you would like in your child’s class, if possible?
Do you have a teacher preference?
MEDICAL INFORMATION AND EMERGENCY CONTACTS
A current immunization/health form must be provided for all students.
Emergency Contact (Please include name, address and phone numbers for person authorized to act on the parent’s behalf if parents are unreachable in an emergency).	*
Child's Physician (Name, Address, Phone Number):
Child's Dentist (please include name, address, and phone number)	*
Please list any known allergies, dietary restrictions, current medications, or other special medical concerns.
Preferred Hospital	*
Consent and Authorization for Medical Treatment 2017-2018
I hereby give my consent to First Baptist Church Joelton Weekday Preschool to act on my behalf in a medical emergency.
I understand that every reasonable effort will be made to notify me. If I am unreachable, other persons authorized to act on my behalf in a medical emergency will be contacted.	*
PHOTOGRAPHY RELEASE
I give permission for photos of my child to use my child’s photo for craft projects or bulletin boards.	*
A SEPERATE SIGNATURE SHEET IS ALSO REQUIRED FOR REGISTRATION. AFTER SUBMITTING THIS FORM, PLEASE DOWNLOAD THE SIGNATURE SHEET AND RETURN ASAP TO KAREN HUNT.

Total	$