4 Year Old Class Registration

This is the Preschool application for the 2018-2019 School Year
Please Note:
Pre-K ( 4-year-old )
Your child must be 4 years old by August 1, 2018
Class Registration

Please select one option.
Pre-K 4

Please select all that apply.
Child Information

 
 
Please select one option.
 
 
 
 
Please select all that apply.
Parent Information

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Family Information

 
 
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Emergency Contact Information (other than parents)

 
 
 
 
 
 
 
 
 
 
Medical Information

 
 
 
 
 
 
 
Medical History

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Please select all that apply.
Payment

 
Other:

 
 
 
 
 
 
 
 
Electric Signature

I consent to the enrollment of my child into the Broadway Baptist Preschool Program, and agree that the Broadway Baptist Church shall not be responsible in case of sickness or in the event that my child is injured while attending Preschool at Broadway Baptist Church. I grant permission for any staff member in charge to administer treatment or obtain necessary medical attention to stabilize my child. I also agree to use my family health insurance as the primary coverage.
Please select all that apply.
 
 
 
 
 
 

Description

This is the Preschool application for the 2018-2019 School Year
Please Note:
Pre-K ( 4-year-old )
Your child must be 4 years old by August 1, 2018