Davis Memorial Christian Church Preschool
Registration Form 2025-2026
Child's Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Area Code and Number
Email
*
example@example.com
Birthday
*
Current Age
Gender
*
Male
Female
Mother's Name
*
First and Last
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment
Employment Phone
Father's Name
*
First and Last
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment
Employment Phone
Back
Next
Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physician to call if child becomes ill or injured:
Name
*
Hospital or Clinic
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
3 Year Old Class (Children must be 3 on or before September 1st)
Monday/Wednesday/Friday
4 Year Old Class (Children must be 4 on or before September 1st)
Monday/Wednesday/Friday
Back
Next
How did you find us?
Sign
Flyer
Google/Other search engine
Facebook
Friend
Hometown Values
Other
If you were referred by a friend, please let us know who so we can thank them!
Signature
*
Submit
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