Course Registration Form

2025-2026

Parkway Baptist PDO Child Registration
Registration Fee ($75 for one child) due within 14 days of registration being turned in or you will forfeit your spot. Registration fee may be paid in office during normal business hours Monday-Thursday, unless other arrangements are made.
Date

MonthDayYear
Date
Student Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian

First NameMiddle NameLast Name
Mobile Number
Parent E-mail
example@example.com
Parent Occupation
Work Number
Parent/Guardian

First NameMiddle NameLast Name
Mobile Number
Parent E-mail
example@example.com
Parent Occupation
Work Number
Allergies (if none type N/A)
Emergency Contact- 3(other than parent) who are allowed to pick up child. List in order to call.
Is there anything else you would like us to know about your child(ren)?

2025-2026