Tabernacle Weekday Registration

Tabernacle Weekday Registration
Child's Name
Date of Birth
Gender

Male Female
Schedule & Tuition
Person Responsible for Tuition Payment
Relationship to Child
Home Phone
Cell Phone
Mailing Address
Email Address
Mother's Name
Mailing Address (if different from above)
Email
Home Phone
Cell Phone
Employer/Occupation
Phone
Father's Name
Mailing Address (if different from above)
Email
Home Phone
Cell Phone
Employer/Occupation
Phone
Child Resides with

Both Natural Parents One Natural Parent Natural Parent & Step-Parent Legal Guardian Foster Parents
Medical Information
Allergies
Prescription Medication Taken Daily
Other Information
Siblings & Ages
Additional Info about your Child
Do you attend church?

Yes No
If yes, where?
List names and phone numbers of people who have permission to pick up your child.
Name
Phone Number
Name
Phone Number
Name
Phone Number
In the event I cannot be reached, I give permission to Tabernacle Weekday Preschool & Kindergarten or its representative to transport my child to Cartersville Medical Center and to authorize medical treatment. I will assume full responsiblity to all charges for any medical treatment.
Type your Name
Today's Date
Tabernacle Weekday Preschool & Kindergarten has my permission to publish my child's photograph in publications, Facebook or other social media, local newspaper, and other forms of publicity.
Select one.

Yes, I give my permission No, I do not want my child's photo published at any time.
Two/Three/Pre-K/Kindergarten Only
My child has permission to attend field trips with Tabernacle Weekday Preschool & Kindergarten during the 2015-2016 school year.
Child's Name
Your Name
Date
How did you hear about us?

Family/Friend Sign Web Newspaper TV Other
Should be Empty:

Tabernacle Weekday Registration

Medical Information

Other Information

Two/Three/Pre-K/Kindergarten Only