First Reformed Church - Preschool Registration

Today's Date

Session:
Mon/Wed a.m. Pre-3 & 4 class
Mon/Wed p.m. Pre-3 & 4 class
Tues/Thurs a.m. Pre-3 class
Tues/Thurs a.m. Pre-4 class

Child's First Name

Last Name

Gender:
Male
Female

Birth date

Age upon entering school:

Child's Address

City

State

Zip/Postal Code

Father's First Name

Last Name

Father's Address

City

State

Zip/Postal Code

Cell Number

Email Address

Place of employment:

Work Phone Number

Mother's First Name

Last Name

Address (if different than above)

City

State

Zip/Postal Code

Cell Number

Email Address

Place of employment:

Work Phone Number

Is the child living with both parents?
Yes
No

If not, with whom? Relationship

Address

City

State

Zip/Postal Code

Names and ages of siblings:

List of people approved to bring and pick up child:

Names of people NOT approved to pick up your child:

Local Church Affiliation:

Would you like to be contacted regarding information about First Reformed Church
Yes
No

Preschool