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Western Hills Christian Preschool Online Registration Form
Child's Full Name
*
Date of Birth
*
MM
DD
YYYY
Father's Name
*
First Name
Last Name
Father's Phone
*
(###)
###
####
Father's Email
*
Mother's Name
*
First Name
Last Name
Mother's Phone
*
(###)
###
####
Mother's Email
*
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Church/Religious Affiliation
Child's Allergies or Chronic Medical Issues
*
Please Check One
*
9:00-12:00
9:00-2:30 (Nap)
9:00-2:30 (No Nap)
Doctor to be called in case of emergency
*
Doctor's Phone
*
(###)
###
####
Relative or Friend or Neighbor to be called if parents cannot be reached
*
Relative/Friend/Neighbor Phone
*
(###)
###
####
Thank you!
