Registration Information Form

REGISTRATION INFORMATION FORM (2024~2025)

This form consists of 3 steps to complete the registration at VRBP for your child once their placement in a class has been confirmed by the Preschool Office. Your child's spot in the class is NOT guaranteed until this form has been completed. Once this information is submitted, you will be charged the $75 Registration Fee based on the financial authorization you provide below. The Preschool Office will notify you of the date that this payment will be processed.
Child's Name:*

First NameLast Name
Father's Name:*

First NameLast Name
Father's Email:*
example@example.com
Father's Phone #:*
Mother's Name:*

First NameLast Name
Mother's Email:*
example@example.com
Mother's Phone #:*
Emergency Contact Designation (Step 1 of 3)

Texas State Licensing requirements mandate that parent(s)/guardian(s) designate someone other than themselves as an Emergency Contact who is authorized to pick-up their child from VRBP if the parent(s)/guardian(s) is/are unreachable in an emergency situation. Texas Health & Human Services §746.605.

This Emergency Contact must be someone other than the child's parent(s)/guardian(s) (such as a friend, relative, neighbor, etc.) allowed to pick-up the child from VRBP when necessary.
Emergency Contact (EC):*

First NameLast Name
Gender (EC):*
Relationship (EC):*
Phone Number (EC):*
Address (EC):*

Street Address

Apartment # (if applicable)

CityState

Zip Code

Financial Authorization (Step 2 of 3)

This section will allow you to select a payment method that will be used to process payments including Registration Fees, Supply Fees, and Tuition Fees.

We are excited to offer the safety, convenience and ease of TUITION EXPRESS - a payment processing system used by Procare that allows secure, on-time Registration, Supply and Tuition Fee automatic payments to be made from either a Bank Account or Credit Union using Electronic Funds Transfer (EFT) or a Credit Card. Accepted credit cards include only VISA and Mastercard. Credit Union members: Please contact your credit union to verify account and routing numbers for automatic payments.

Based on your selection, please note the following:
- Bank Account EFT - there is NO FEE
- VISA or Mastercard - a credit card processing FEE (approx. 3.35%) will be charged to the cardholder
AUTHORIZATION for Payment Processing

I (we) hereby authorize VALLEY RANCH BAPTIST PRESCHOOL to initiate debit entries to my (our) checking or savings account OR credit card charges to my (our) credit card account based on my (our) account information below. To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice.
Payment Option:*

Bank Account EFTCredit Card Payment (Visa/Mastercard Only)
Account Type:*

Checking AccountSavings Account
Routing Number:*
Account Number:*
Account Holder:*

First NameLast Name
Account Holder Phone:*
Bank or Credit Union:*
Enter Name of Institution
For SECURITY REASONS:

We will contact you to collect your Credit Card Number and expiration date!
Card Type:*

VisaMastercard
Name on Card:*

First Name & M.I.Last Name
Cardholder Phone:*
Cardholder Address:*

Billing Street Address

Apartment # (if applicable)

CityState

Zip Code
Electronic Signature:*

Clear
Today's Date:*

MonthDayYear

Participation Agreement and Authorization Form (Step 3 of 3)

Prior to completing this form for enrollment in Valley Ranch Baptist Preschool (VRBP) - please note that the VRBP Handbook is available on the Home page of our website at www.vrbp.net and by signing below, you are acknowledging that you have read this Handbook.
Acknowledgement & Authorization

VRBP Handbook:
I have read, understand and agree to comply with all requirements, including but not limited to, Health & Safety Protocols and Financial terms set forth in the VRBP Handbook. This handbook is available on the Home page of the preschool website: www.vrbp.net

Participation Authorization Including Releases and Indemnity Agreement:
I authorize my child to participate in all VRBP programs and activities including those involving water (referred to as "Activities"). I acknowledge that participation in Activities involves risk to the child, parent(s)/guardian(s), and other family members (collectively referred to as "Participants") and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, emotional injury, personal injury, death, property damage, and financial damage.

In consideration for the Participants' opportunity to engage in Activities, I acknowledge and accept the associated risks for Participants. I accept personal responsibility for any injury or other loss sustained while at VRBP and Valley Ranch Baptist Church (VRBC). I accept personal financial responsibility for injury or other loss during Activities, as well as for any medical treatment rendered to the Participants that is authorized by VRBP and/or VRBC, or either of their agents, employees, volunteers, or any other representatives (collectively referred to as "VRB Representatives"). Further, I release and promise to indemnify, defend and hold harmless VRBP, VRBC, and VRB Representatives for any injury arising directly or indirectly out of the Activities, whether such injury arises out of negligence of VRBP, VRBC, VRB Representatives, Participants or otherwise.

If a dispute over the Participation Agreement and Authorization or any claim for damages arises, the Participants (excluding minors) agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participants and VRBC/VRBP cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

Parent Approval Signature:
I have been given an opportunity to ask questions regarding this Agreement and Authorization Form, the VRBP Handbook and other documents. I may review the contents of the aforementioned with an attorney of my choosing, and I am under no legal obligation to enroll my child in VRBP. By signing below, I am agreeing that I have the authority to make these representations, all representations are accurate and true and I am 18 years of age or older.

I authorize my child to participate in all VRBP programs and activities including those involving water (referred to as "Activities"). I have read the Participation Authorization Including Releases and Indemnity Agreement, and I agree to everything set forth therein including the releases, indemnity and hold harmless provisions.

I hereby acknowledge & agree to comply with the following policies set forth in the VRBP Handbook:
- Health and Safety Guidelines
- Discipline and Guidance Policy
- Financial Terms and Obligations
- Sign-In and Sign-Out Policies
I hereby give permission and authorization for VRBP regarding:
- Medical Emergency Guidelines
- Photo Use Policy
Parent / Guardian Printed Name:*

First NameLast Name
Electronic Signature:*

Clear
Today's Date:*

MonthDayYear
If you would like to print the Registration Information to keep for your records, please click on the "PRINT Form" button below first, and then click "SUBMIT Registration" to submit the form.
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REGISTRATION INFORMATION FORM (2024~2025)

Financial Authorization (Step 2 of 3)