Smart PDF Form

Fifth Avenue Baptist Nursery and Preschool
1135 5^th Avenue
Huntington, WV 25701
P: (304)525.5441
F: (304)697.8469
Registration Form
Please fill out completely
Registration Fee: $50 (non-refundable)
*Due one time upon the first day of enrollment.
*The registration fee will be applied to your account again if you leave FAB for an extended period and then return.
Forms needed before the child's first day:
- Registration Form
- Emergency Cards
- Signed Payment Contract
- Pick Up Authorization
- Permission Slips
- Current Health Check/Wellness Check
Child's Information:
Child's Name:
Birthday:

MonthDayYear
Date
Complete Address:
Schedule of Days:
Schedule of Hours:
*Known Allergies:
*History of serious illness or injury?
*Recent Stressful Experience?
*Please use the back of this form if you need to share more details.
Parent/Guardian Information:
Name:
Email:
example@example.com
Primary Phone:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Employer:
Work Address:
Parent/Guardian Information:
Name:
Email:
example@example.com
Primary Phone:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Employer:
Work Address:
Any Special Information: (custody agreement, foster care agreement)
Signature of Parent/Guardian:

Clear
Date:

MonthDayYear
Date
Should be Empty: