ENROLLMENT FORM
After submitting this online form, in order to complete the enrollment process, mail or bring by the $60 non-refundable enrollment fee to:
First Baptist Church of Lamar, PO Box 426,
1301 E. 6th Street, Lamar, MO 64759
Make checks payable to FBC’s & 123’s
CHILD'S NAME (First, Middle, Last) *
Your answer
BIRTH DATE *
MM
/
DD
/
YYYY
*
MAILING ADDRESS *
Your answer
MOTHER'S NAME
Your answer
MOTHER'S ADDRESS (only if different)
Your answer
MOTHER'S PHONE NUMBER
Your answer
MOTHER'S EMAIL ADDRESS
Your answer
FATHER'S NAME
Your answer
FATHER'S ADDRESS (only if different)
Your answer
FATHER'S PHONE NUMBER
Your answer
FATHER'S EMAIL ADDRESS
Your answer
SIBLINGS (Names & Ages)
Your answer
NAME OF EMERGENCY CONTACT OTHER THAN PARENT *
Your answer
RELATIONSHIP OF EMERGENCY CONTACT *
Your answer
EMERGENCY CONTACT PHONE NUMBER *
Your answer
EMERGENCY CONTACT ADDRESS
Your answer
PLEASE LIST ALL PEOPLE (other than parent) WHO ARE ALLOWED TO PICK UP YOUR CHILD FROM PRESCHOOL *
Your answer
HOME CHURCH (if applicable)
Your answer
PLEASE TELL US ABOUT ANY ALLERGIES, SPECIAL MEDICAL CONDITIONS, (Including Chronic Health Problems or Disabilities) SPECIAL MEDICATIONS, AND/OR RESTRICTIONS:
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