City Church Preschool Enrollment Form

City Church Preschool Enrollment Form Thank you for your interest in City Church Preschool! Please fill out this form completely to enroll your child. Child's Information First Name Middle Name Last Name Preferred Name Birth Date Gender Male Female Non-binary Date of Application Applying for which class? Two's Class Three's Class VPK VPK Wrap Around Has your child been in a classroom setting before? Yes No If yes, where? Family Information Mother/Guardian Information First Name Last Name Relationship to Child Address City State Zip Code Cell Phone Email Employer Work Phone Father/Guardian Information First Name Last Name Relationship to Child Address City State Zip Code Cell Phone Email Employer Work Phone Emergency Contacts (Other than Parents/Guardians listed above) Emergency Contact 1 First Name Last Name Relationship to Child Phone Number Emergency Contact 2 First Name Last Name Relationship to Child Phone Number Medical Information Physician Name Physician Phone Insurance Company Insurance Policy Number Allergies Does your child have any allergies? Yes No If yes, please list all allergies and reactions Medical Conditions Does your child have any medical conditions we need to be aware of? Yes No If yes, please list all medical conditions Medications Is your child currently taking any medication? Yes No If yes, please list all medications and dosages Permissions I give permission for my child to participate in all school activities, including field trips. Yes No I give permission for my child to be photographed and/or videoed for school purposes. Yes No I have read and understand the City Church Preschool Parent Handbook. Yes No Signature Date