Preschool Information Form — First Baptist Church

Child's Name

First Name

Last Name

Address (Street, City, Zip)

Child's Birth Date

MM

DD

YYYY

Mom's Name

Mom's Cell Phone

(###)

###

####

Dad's Name

Dad's Cell Phone

(###)

###

####

Preferred Email Address

Home Phone

(###)

###

####

Siblings (with ages)

Who may pick up your child from class?

Allergies:

Special Instructions or helpful information:

Favorite Things: (toy, food, pet's name, blanket...)