4 & 5 Year Old Learning Tree Waitlist 2025
Age as of 9/1/25
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Email *
Child's Full Name *
Name Used at Home *
Child's Gender *
Child's Birth Date: *
MM
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DD
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Child's Age (As of 9/1/25) ("____ years, ___ months") *
Parent/Guardian Names *
Home Address (street address, city, state, zip code) *
Contact Phone Number *
Email Address (You will receive email communication from the office and director) *
How did you hear about Learning Tree? *
How many days/week do you want your child attending? *
Which days would you prefer your child attend?  *
Required
Sibling name(s) also attending Learning Tree:
*Please remember to complete a registration form for them, too!
I understand that if a spot opens up, the registration fee I am to pay is a one time, non-refundable fee, and my registration will not be complete until it is paid. I understand that PMBC Learning Tree is not a licensed child care program, rather a ministry of Pickett's Mill Baptist Church. *
Parent/Guardian: Signature below *
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