Bishopville Prep Enrollment Registration Form
Please fill out the required information to enroll your child in preschool.
Child's Class Level
Child's Full Name
*
First Name
Middle Name
Last Name
Suffix
Child's Nickname or called by name
Date of Birth
*
-
Month
-
Day
Year
Date
Male/Female
Male
Female
Child's Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child Lives With
both parents
mother
father
grandparent(s)
other
Mother's (1st Guardian) Name
*
First Name
Last Name
Mother's (1st Guardian) Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's (1st Guardian) Email Address
*
example@example.com
Father's (2nd Guardian) Name
First Name
Last Name
Father's (2nd Guardian) Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Father's (2nd Guardian) Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child
Second Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child
Last year my child was cared for by...
a public provider (Headstart/ Public School PreK etc)
a private provider (full day or half day private school or daycare)
home environment (relative or non-relative)
Primary language spoken in home
Does your child have any allergies, medical conditions, or special needs?
*
Does your child have any emotional, social, or behavior concerns of which we should be aware?
*
Name and phone number of all individuals who ARE ALLOWED to pick up child
Picture ID will be required EVERY time.
Are there any individuals who ARE NOT allowed to pick up child
anyone not on the approved list will wait while we obtain verbal or text confirmation from parent/guardian
Immunization Records
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Child's Picture (to add to their cubby and folders so they know they belong)
*
Browse Files
Drag and drop files here
Choose a file
Pictures will not be shared or posted
Cancel
of
Signature indicates that all information is accurate. It is my intention to enroll the listed child to Bishopville Prep Preschool for the school year 2026/2027
*
Enrollment Check List
*
Submit Registration
Should be Empty: