Calvary Christian Preschool Registration Form
Please fill out all information. Type "None" if information is not available.

Provide email for parent responsible for billing Office use only/toured yes no
Registration Fee Paid yes no

Email address *
Registration for
Child Last, First Name *
Your answer
Child Middle Name *
Your answer
Child Preferred Name *
Your answer
Gender *
Birth date (xx/xx/xxxx) *
Your answer
Mother's Last, First Name *
Your answer
Mother's email *
Your answer
Mother's Cell Phone *
Your answer
Father's Last, First Name *
Your answer
Father's email *
Your answer
Father's Cell Phone *
Your answer
Marital Status
Address *
Your answer
Church Affiliation (type None if not affiliated with any church). *
Your answer
Allergies *
Required
If yes, list allergies
Your answer
Epi Pen *
Required
I suspect my child has problems with or has been serviced for any of the following. Check all that apply *
Required
List any other medical issues your child has had. (ie. seizures, heart, respiratory, etc.) Type N/A if Not Applicable. *
Your answer
Child's Physician Name and Number (separate by comma) *
Your answer
Insurance Carrier and Policy Number (separate by comma) *
Your answer
Emergency Contact/Pick-up Name and Phone Number (separate by comma)
Your answer
Emergency Contact/Pick-up Name and Phone Number (separate by comma)
Your answer
Emergency Contact/Pick-up Name and Phone Number (separate by comma)
Your answer
How did you hear about us?
Your answer
Siblings names and ages
Your answer
Is your child potty trained? *
Does your child attend Sunday school regularly?
Would either parent be interested in being a guest speaker for Occupation Day?
Occupation
Your answer
Please rate your child below: Passive or Assertive *
Passive
Assertive
Dependent or Independent *
Dependent
Independent
Obedient or Willful *
Obedient
Willful
I give permission to have my contact information released to other parents in my child's classroom. *
Required
I have read the Calvary Christian Preschool in its entirety, support the school's policies as set forth therein, and recognize my need for compliance to the policies. I release Calvary Baptist Church of Simpsonville, Inc. and Calvary Christian School, a ministry of Calvary Baptist Church, or its agents, employees, successors or assigns from all liability of any kind in the event my child is injured at school or during any school activity. I do hereby authorize Calvary Baptist Church to use their judgment in seeking treatment for this child in case of an emergency. *
Required
Date submitted *
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Comments
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