FBCDS Reg Form

Age Group*
Class Preference*
Class Preference (Days) if it isn't listed above:
This preference is not guaranteed but we would like to meet your needs as much as possible.

Primary Email*
example@example.com
Secondary Email
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mother's Name*

First NameLast Name
Mother's Phone Number*

Area CodePhone Number
Mother's Occupation
Father's Name*

First NameLast Name
Father's Phone Number *

Area CodePhone Number
Father's Occupation
May we include your primary contact information on our internal roster to be distributed ONLY to Day School families?*

YesNo
Are the Parents

MarriedDivorcedSeparatedSingleDeceased
Church Affiliation

List Known Allergies*
Type NONE if there are no known allergy concerns
3 and 4 yr olds MUST be day-time potty-trained. Is your child day-time potty-trained*

YesNoWill be for school
What language(s) does your child speak?
Does Your Child Understand English?

YesNo
Has Your Child Attended Preschool or a Mother's Day Out?

YesNo
Name of Preschool or Mother's Day Out last attended
Child's Favorite Activity
List Known Fears

First Baptist Christian Day School STUDENT REGISTRATION