1 Child Information2 Guardians3 Emergency Contacts4 Other Information New Child InformationChild Name* First Name Last Name Birthday* Date Format: MM slash DD slash YYYY Gender*Select GenderMaleFemaleUnknownChild PhotoAllergies(Optional)AllergyNotes Class*Select ClassTeal Room Infant 1Blue Room Infant 2Green Room Pre-SchoolRed Room Pre-KYellow Room Toddler 1After School ProgramOrange Room Toddler 2Schedule*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?*YesNoDoes your child nap at home?*YesNoIs your child potty trained?*YesNoDoes your child speak well, fairly well, or not at all?*WellFairly WellNot at allAny special eating habits/difficulties?*YesNoPlease 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?*YesNoPlease 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?*YesNoPlease Explain Attendance Information What is the anticipated start date for your child?* Date Format: 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*YesNo 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 OccupationEmail 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 OccupationEmail 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 NameThis field is for validation purposes and should be left unchanged.
