25/26 3YR Bright Beginnings Preschool Registration
*LIMITED SPOTS
*Child is only considered "registered"  when a:
Completed registration form, payment of registration fee ($100)
Up-to-date immunization form #3231 has been provided .
Parent Agreement has been signed

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Child's Full Name *
Child's Date of Birth *
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DD
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Gender *
Parents/Guardians Name *
Home Address *
Cell Phone # *
Primary Email Address *
Siblings Name & Ages
Emergency Contact  (if parents are unavailable) *
Persons Authorized to pick up child with phone #. (Under no circumstances will the child be released to anyone not on this list without written authorization from parents or guardians) *
Are you a member of a church? If so where..
Would you like more information about Southside Baptist Church
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Please list any health problems or handicaps your child has. (Ex. allergies, diabetes, vision, etc..)
Physician's Name & Phone Number
Can child dress himself?
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Right Handed or Left Handed
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Does he or she let you know he/she needs to go to the potty?
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Areas where your child may need extra attention.
Does he/she like to play with other children?
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Does he/she have exposure to children outside the immediate family?
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Does he/she have exposure to adults outside the immediate family?
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As a parent/family member, would you be interested in volunteering in the classroom at various time throughout the year?
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