Faith Baptist
Preschool Academy
Registration Form

Child's Last Name

Child's First Name

Birthdate

Gender

Male

Female

Allergies

Yes

No

List of Allergies

Address

City

State

Zip Code

Dad's First Name

Dad's Last Name

Dad's Cell Number

Dad's Work Number

Dad's Email

Church

Mom's First Name

Mom's Last Name

Mom's Cell Number

Mom's work Number

Email

Church

Childcare Provider

Childcare Provider Number

Emergency Contact full Name

Emergency Contact Number

Session Enrolled

Please choose one of the following options for your child:

Small Fry Wed AM

First Step Tues/Thurs AM

First Step Mon/Wed/Fri AM

First Step Tues/Wed/Thurs PM

Pre-K Mon-Thurs AM

Pre-K Mon-Thurs PM

Enrichment M-F AM