Child's Full Name:*
Please check the days for which this child is enrolling: *
Child's Gender: *
Child's T-shirt Size: *
Mother's Full Name:*
Father's Full Name:*
Mother's Work Phone
Mother's Cell Phone:
Mother's E-mail Address:
Father's Work Phone:
Father's Cell Phone:
Medical, Emergency and Other
Name of Church Currently Attending:
With whom does the child currently live?*
Emergency Contact (other than parents):*
Emergency Contact Phone:*
Persons who have permission to pick up child at preschool (please list names and numbers): *
Allergies (e.g., foods, medications, animals): *
Other things that we may need to know about your child (e.g., sleep habits, eating habits, fears, behavioral concerns) :
Has your child attended another preschool program, and if so, where?
Does your child have any serious illness?
Full Name of Child's Doctor:*
Siblings (please give names and ages):
Authorizations & Waivers
I authorize my child to receive medical treatment should it become necessary. I also authorize church personnel to secure the use of an ambulance if necessary for transporting my child to the nearest facility.
I give permission for my child to use all of the play equipment and participate in all the activities of the preschool. I hereby release AHBC and personel from any and all liabilities that might incur while attending WEE. I give permission for my child to be included in evaluations and pictures connected with the preschool program.
I agree to pay the monthly tuition dues between the first and the tenth of each month. I understand that this is not refundable and the total amount is to be paid regardless of the number of days my child is absent.