Let's Get StartedRegistration1 Child’s Information2 Parent/Guardian’s3 Medical Information4 Family Facts5 Enrollment SelectionName* First Last Preferred NameFor our use.Date of Birth* Gender*MaleFemaleAddress* Street Address Address Line 2 City ZIP Code Parent/Guardian Information Name Home Phone Cell Phone Work Phone Email  EditDelete There are no Parent's/Guardian's. Add Parent/Guardian Contacts/Emergency ContactsChildren will be released only to these authorized people listed. As well as the Parents/Guardians listed above.NameWork phoneHome Phone I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted. DoctorLocationPhoneAreas of Concern*Please list allergies, special medical or dietary needs, or any other areas of concern. Names & Ages of SiblingsNameAge Supplemental InformationPlease list any other information that might help us to better understand your child (i.e. fears, recent death or divorce in the family, a new baby, adoption, and what the child has been told about these events.At what church do you worship or serve?*Previous preschool/small group experiences?* Pricing InformationPlease reference this chart for pricing information.Enrollment Start Date* Age on Enrollment Date*This is used to determine enrollment options, please be accurate with your input.Please enter a value between 1 and 5.Day Duration*Preschool Day (8:30-12:30)School Day (8:30-2:30)Full Day (7:30-5:30)Please note due to capacity restraints the 3 and 5 day two year old classes are fully reserved.Please only proceed with the application if you wish to be added to a waitlist.Days Per Week*2 Day (Mon/Tues)3 Day (Wed/Thurs/Friday)5 Day (Mon-Friday)Do You Need Extra Care?*YesNoHow often do you need Extra Care?*2 Days Per Week3 Days Per Week5 Days Per WeekExtra Care Priced on a Per Month Basis.When do you need Extra Care?*Mornings (7:30-830)Afternoons (2:30-3:30)Ext. Afternoons (2:30-5:30)NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.