Enroll | Great Beginnings Christian Preschool & Kindergarten

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Parent/Guardian #1

First Name

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Last Name

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Middle Name

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Email Address

This email will receive important communications

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Cell Phone

Home Phone

Work Phone

Ext.

Street Address

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Apt/Suite

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City

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Zip Code

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Is English your first language? *

Yes

No

Employer

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Employer's Phone Number

Is this a single parent/guardian home? *

Yes

No

Parent/Guardian #2

First Name

Single parent/guardian homes, please enter N/A

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Last Name

Single parent/guardian homes, please enter N/A

0 / 50

Email Address

Single parent/guardian homes, please enter N/A

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Cell Phone

Single parent/guardian homes, please enter 000-000-0000

Is English your first language? *

Yes

No

Employer

Single parent/guardian homes, please enter N/A

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Employer's Phone Number

General Account Info

Emergency Contact

Please do not use a parent/guardian already listed. In the event we are unable to reach the parents/guardians listed, this individual will be responsible for making medical decisions for your child.

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Emergency Phone

This must be a new number.

Child's Doctor Name

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Child's Doctor Phone #

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Is your child currently under medical treatment? *

Yes

No

Does your child have restrictions on physical activities? *

Yes

No

Is your child's immunization record up to date? Please Provide. If no, update as soon as possible *

Yes

No

NOTE: IMMUNIZATION RECORDS ARE DUE TO YOUR TEACHER BY FIRST WEEK OF SCHOOL.

Please provide the school office with a copy of your child's immunization records before the start of the school year. KG parents, please provide your child's most recent physical as well.

MEDICAL LIABILITY RELEASE: If unable to be contacted in the event of an emergency, I give my permission to Great Beginnings Preschool & Kindergarten Staff to arrange emergency medical treatment. *

Yes

No

Program Selection

By confirming, you hereby guarantee payment and agree to our terms and conditions, see parent handbook.

Great Beginnings Christian Preschool & Kindergarten

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Payment method
Amount due	USD $0.00

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