PRBC Preschool Registration - Summer 2025 and School Year 2025-2026 
Please answer all questions. Please be aware that your child is not officially registered until the registration fee is paid. PRBC Preschool cannot accommodate for scheduled or individual days. Hours of operation are listed below. SEPARATE REGISTRATION FORMS MUST COMPLETED FOR EACH CHILD YOU ARE REGISTERING.
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Email *
Hours of Operation
Summer - Tuesday through Thursday (drop off begins at 8:15 and pick-up will start at 12:45) 
  • Weeks of June 9th, 16th, and 23rd (Off the week of June 30th) 
  • Weeks of July 7th, 14th, and 21st

School Year - Tuesday through Friday (drop off begins at 8:15 and pick-up will start at 12:45)
  • First Day - August 12, 2025
  • Last Day - May 14, 2026
Statement of Understanding *
I am enrolling for (Pick one or both) *
Required
Age Group *
Child's Information
Child's First Name *
Child's Last Name *
Child's Preferred Name
Child's Current Age *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Sex *
Child's Residence/Home Address
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
Primary Phone # *
Secondary Phone # *
Please identify the person(s) who have legal custody of the child, include relationship. *
Please provide documentation such as custody orders, etc.
The Child's parents are *
Father's/Guardian Information
First Name
Last Name
Father's Spouse (If other than Child's Mother)
Father's Place of Employment
Father's Cell Number
Father's Work Number
Father's E-mail
Mother's/Guardian Information
First Name
Last Name
Mother's Spouse (If other than Child's Father)
Place of Employment
Mother's Cell Number
Mother's Work Number
Mother's E-mail
Do the parents and children all live in the same home?
Does your child have previous preschool or child care experience? If YES, please describe below.
Please list at least three (3) people we can contact if a parent cannot be located in the case of an emergency. These individuals will also be authorized to pick up your child.
Please keep all the contact numbers updated. This is very important in case we need to reach you in an emergency.
Emergency Contact 1
First Name *
Last Name *
Phone Number *
Relationship to child *
Pick-up *
Required
Emergency Contact 2
First Name *
Last Name *
Phone Number *
Relationship to child *
Pick-Up *
Required
Emergency Contact 3
First Name *
Last Name *
Phone Number *
Relationship to child *
Pick-Up *
Required
Is there anyone who CANNOT pick up your child? Please provide names here. If none, please put "none."

 *
Is there anyone who CANNOT HAVE ANY CONTACT with your child? Please name and explain. This information will only be shared with individuals who are the primary contacts (teachers and directors) at the preschool. If none, please put "none."
 *
Does your child have siblings or live with other children?
Please list the names and ages of other children in the home.
General Information
Does your child have any specific fears?
Does your child make friends easily?
What are your child's favorite activities?
What are your child's favorite TV shows?
Does your child attend Sunday School? *
Where does your family attend  church? *
Permissions
We will occasionally take pictures of our preschool children during their activities.
May we have permission to photograph your child? (For making crafts with the child's picture.) *
Required
May we have permission to use your child's picture in church publications for the purpose of promotions? This would include pictures on the preschool Facebook page. This allows parents see some of the fun the children are having.  *
Medical Information/Permission for Emergency Medical Treatment
At or before orientation, I will be required to complete a medical information sheet for my child which will include insurance information and preferences. In the event of a medical emergency, when I cannot be reached, I hereby give permission for Pleasant Ridge Baptist Church Preschool to arrange emergency transportation to the hospital and for a licensed physician to provide medical care for my child. Any qualified person providing such required medical attention, treatment, or services may accept this consent as if given by me in person. I agree to assume responsibility for payment of all medical costs incurred, including that of emergency transportation to the hospital. I understand that Pleasant Ridge Baptist Church Preschool will make every effort to contact me as soon as possible.
Who is your child's primary care physician? *
Primary Care Phone # and Address *
I have read and agree with the above statement on medical treatment. *
Please list any allergies along with a description of the reaction and treatment for the reaction.
Does the child require use of an inhaler *
Please list any medications or drugs taken regularly by the child. (If none, put "none") *
Please describe the general health of your child. *
Signature (Please type your full name) *
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