Mother`s Day Out @ First Baptist Royse city

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: ___________