Airline Baptist Church - LA - Weekday Preschool Registration Form

Mom's Day Out and Preschool

4007 Airline Drive
Bossier City, La 71111
316-746-2799

MDO/ Weekday Preschool Registration Form

Are you interested in MDO, Preschool or Bridge?

Mom's Day Out (six weeks -3 yrs)

Preschool: 4 days/ week (3 yrs old by September 30th)

Bridge: 4 days/ week ( 5 yrs old by end of calendar year)

if MDO? Which Days?

2 days

3 days

4 days

Child's First Name

Child's Last Name

Today's date

Child's Gender

Child's Birthdate

Child's Age

Child's Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Special Instructions/ Allergies:

Parent/Guardian Information:

Dad's First Name

Last Name

Dad's Phone Number

Dad's Email

Mom's First Name

Last Name

Mom's Phone Number

Mom's Email

Guardian's First Name

Last Name

Guardian's Phone Number

Guardian's Email

Child lives with

Mom

Dad

Other

Best to contact:

Mom

Dad

Other

Does your family belong to a church?

Yes

If, Yes Where?

Siblings:

Sibling Name

Age

Sibling Name

Age

Sibling Name

Age

Sibling Name

Age

Emergency Contacts:

Emergency Contact First Name

Last Name

Phone Number

Emergency Contact First Name

Last Name

Phone Number

Authorized to remove child from school:

Authorized Pick Up First Name

Last Name

Phone Number

Relationship

Authorized Pick up First Name

Last Name

Phone Number

Relationship

Authorized Pick Up First Name

Last Name

Phone Number

Relationship

Authorized Pick Up First Name

Last Name

Phone Number

Relationship

NOT Authorized to remove child from school:

Not Allowed to pick up First Name

Last Name

All Information given today is correct to the best of my knowledge.

Signature

MDO/ Weekday Preschool Registration Form

Parent/Guardian Information:

Siblings:

Emergency Contacts:

Authorized to remove child from school:

NOT Authorized to remove child from school:

All Information given today is correct to the best of my knowledge.

Contact Info

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