Mother’s Day Out @ First Baptist Royse City Registration Form 2015-2016 Child’s Name____________________________________________ M/F________ Birth Date______/______/________ Age on 9/1/15________ Home Address ___________________________________Phone________________ City______________________________ State______ zip code________________ Mother’s Name_________________________________ Cell#__________________ Occupation______________________________ Driver’s License_________________ Father’s Name _________________________________ Cell#__________________ Occupation _____________________________ Driver’s License_________________ Email address:__________________________________________________ (Please print clearly) Church Affiliation____________________________ Member? Yes or No Person other than parent to be contacted in case of illness or emergency: Name_________________________ Relationship _________Phone_________________ Name_________________________ Relationship _________Phone_________________ In order to provide the safest environment possible for your child, we ask that you list anyone other than those persons listed above to whom we may release your child. Name__________________________________ Driver’s License_______________ Name__________________________________ Driver’s License_______________ Getting Acquainted with your Family Has the child been in a structured preschool program before?_____________ Other Children in the Family: Name_______________________________________ Age_________ Name_______________________________________ Age_________ Name_______________________________________ Age_________ Are there any changes in your child’s life we should be aware of? _____________________________________________________________________ _____________________________________________________________________ Health Restrictions: Foods allergies: ___________________________________________________ Health: __________________________________________________________ Special Needs (such as physical, emotional, or delayed development): ________________________________________________________________ ________________________________________________________________ Does your child have a daytime nap? Y/ N Fully Potty trained (Age 3+)? Yes Would you be interested in subbing for a discount on tuition? Yes No No Occasionally parents may request phone numbers and addresses for purposes such as sending invitations, cards, etc. May we release this information? Yes No Occasionally we will post pictures of our classroom activities on our websites, including Facebook, as well as for flyers in the community. Photos are for our MDO families to view as well as to advertise our program. No names will be used in conjunction with these pictures. Can your student be included in these pictures? Yes No What expectations do you have of our program for your child? _________________________________________________________________________ I would like to register my child for: ____ 2 days a week: $100 Registration/Fall Supply fee $50 Spring Supply fee (Due Jan) $140 Monthly tuition *Please return this form along with a $100.00 non-refundable deposit. This is the registration and fall supply fee. Please make all checks payable to First Baptist Church Royse City or FBRC. Class enrollment is based on the child’s birthdate. The handbook will be sent via email during summer break. The handbook includes valuable information and forms that will need to be completed and returned on the first day of school. You will be notified of class assignments at Open House/Meet the Teacher. Parent Signature: __________________________________________ Date: ___________