First Friends Registration

Child's Name

Child's Gender

Child's Age

Child's Date Of Birth

Home Address

City

State

Zip Code

Home Phone #

 

Father's Name

Father's Cell Phone

Father's Employer

Father's Employer Phone

 

Mother's Name

Mother's Cell

Mother's Employer

Mother's Employer Phone

 

Child 2 Name  Age  Gender   

Child 3 Name  Age  Gender

Child 4 Name  Age  Gender

 

Please list people other than parents to whom your child may be released.

Release 1 Name  Phone #  Relationship

Release 2 Name  Phone #  Relationship

Release 3 Name  Phone #  Relationship

Note:If the child is to be released to someone other than parents or the listed then a note is required with your signature on that day.

 

Does the child:

Have Allergies (if so please list)

 

Take Medications (if so please list)

 

Have Any Other Conditions We Should Know About      

 

How did you learn about our preschool? (place an x in the box if yes) 

Times Bulletin          Other Parents     Channel 4     

Other(please explain)

 

E-mail Address (without this we will not be able to complete your registration)  

Registration is not complete until we have received you non-refundable registration fee of $40.