[vc_section][vc_row][vc_column width=”1/4″][/vc_column][vc_column width=”1/2″][vc_empty_space height=”50px”] 1Child Information2Guardians3Emergency Contacts4Other Information New Child InformationChild Name* First Name Last Name Birthday* MM slash DD slash YYYY Gender*Select GenderMaleFemaleUnknownChild PhotoMax. file size: 50 MB.Allergies(Optional)AllergyNotes Class*Select ClassTeal Room Infant 1Blue Room Infant 2Yellow Room Toddler 1Orange Room Toddler 2Green Room Pre-SchoolSchedule*Select Schedule5 Days per week3 Days per week2 Days per weekFlex Child Information Name Student Prefers to be called* Social Security Number* Is this your child's first school experience?* Yes No Does your child nap at home?* Yes No Is your child potty trained?* Yes No Does your child speak well, fairly well, or not at all?* Well Fairly Well Not at all Any special eating habits/difficulties?* Yes No Please Explain Child Medical Information Pediatrician* Pediatrician's Address* Pediatrician's Phone Number* Immunization records must be submitted before a child can start attendance. Please check the box below to let us know you have read this info and will be getting that information sent for our records from your child's Pediatrician. Thanks!*SelectYes, I will get that information to you before my childs first day!I have read the above, and have further questions about these requirementsDoes your child have allergies?* Yes No Please explain specific symptoms and or causes of which the teacher needs to be made aware of?* Are there any other physical problems of which his/her teacher should be made aware?* Yes No Please Explain Attendance Information What is the anticipated start date for your child?* MM slash DD slash YYYY Family Information Are you part of Generations Church or another church family? If so, which one?* Brothers and Sisters- Name/Age/School* Emergency Medical Care I do hereby authorize emergency medical care* Yes No Please Note: All classes are subject to change based on availability and enrollment. We prayerfully consider the placement of each and every child and we take many things into consideration when placing children in a particular class. Guardian InformationName* First Name Last Name Relationship*SelectAuntBoyfriendFatherFather in LawFriendGrandparentsMotherMother in LawNannyNieceSisterSpouseUncleUnknown Allowed to Pickup Home Address* Street City Zip/Postal Work Address* Street City Zip/Postal Occupation Email Address* Phone Numbers Cell Phone*Home PhoneWork Phone Add Another Guardian Guardian 2 InformationName* First Name Last Name Relationship*SelectAuntBoyfriendFatherFather in LawFriendGrandparentsMotherMother in LawNannyNieceSisterSpouseUncleUnknown Allowed to Pickup Home Address* Street City Zip/Postal Work Address* Street City Zip/Postal Occupation Email Address* Phone Numbers Cell Phone*Home PhoneWork Phone New Contact InformationContact Name* Contact Name Relationship*SelectAuntBoyfriendFatherFather in LawFriendGrandparentsMotherMother in LawNannyNieceSisterSpouseUncleUnknown Emergency Contact Allowed to Pickup Home Address* Street City Zip/Postal Work Address Street City Zip/Postal Email Address* Phone Numbers Cell Phone*Home PhoneWork PhoneOther Phone Other InformationDoctor* Doctor Name Profession*SelectFamily DoctorOtherAddress Street City Zip/Postal Additional Information There is a $75 Registration Fee which needs to be paid to the center before your spot is guaranteed. * I have read and agree to the terms above PhoneThis field is for validation purposes and should be left unchanged. [/vc_column][vc_column width=”1/4″][/vc_column][/vc_row][/vc_section]
