PDO & Preschool Program Registration

Child's Name*

First Last

Preferred Name

Address*

Street Address Address Line 2 City State ZIP Code

Child's Date of Birth*

Child's Age on August 15, 2021*

Is there any information that we need to know about your child?

(Special health or developmental concerns, allergies, fears, etc.)

Child's T-shirt Size*

How did you hear about our program?*

Parent/Guardian Information

Mother's Name*

First Last

Marital Status

Occupation

Address

(if different from child)

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Home Phone

Work Phone

Email Address*

Are you on Facebook?

Yes
No

Father's Name*

First Last

Marital Status

Occupation

Address

(if different from child)

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Home Phone

Work Phone

Email Address*

Are you on Facebook?

Yes
No

Personal Information

Please list siblings’ names and ages:

Name	Age

Does your family attend church?*

Yes
No

What church does your family attend?

Has your child ever been in a childcare or preschool program?*

Yes
No

What program(s) did your child attend?

Please list the name and phone number of at least two people (other than parents) who are allowed to pick up your child.*

If we need to contact you and cannot reach you, we will call these people in the order listed.

Allergy & Medical Information

My child has known health problems which would affect his/her school day.*

Yes
No

My child's health-needs include the following conditions:

Select All
Allergies
ADD or ADHD (diagnosed)
Asthma
Diabetes
Hearing or vision problems
Seizures
Other

Please specify your child's kind of allergies:*

Seasonal
Bees
Food

Please specify your child's diabetic condition:*

Type 1
Type 2
Takes Insulin

Please specify the type of seizure(s) your child has had:*

Date of child's last seizure*

Child's Doctor*

First Last

Phone Number for Child's Doctor*

Hospital Preference:

Please list any medications your child takes on a regular basis:

Please list any other health information for your child:

Permission for Photographs

All photographs taken at Ball Camp Baptist Church will be used within the program for displays and/or for our church’s website and Facebook page. We will never post your child’s name or any personal information about your child with any of their pictures.

Permission*

Yes, photos may be taken of my child and used in displays, advertisements, on the church website, and on BCBC PDO and BCBC Facebook pages.
No, photos may not be taken of my child and used in displays, advertisements, on the church website, or on BCBC PDO and BCBC Facebook pages.

Parent/Guardian Signature*

Date*

Potty Training

We realize that all children attending our program are at different stages of potty training. Please check the appropriate box for your child’s potty-training routine. We will assist all children in their potty-training routines any way we can.

Potty-Training Routine Details*

**Please note: Your child MUST be potty-trained before entering into our 3-year-old class.

My child is in diapers.
My child is in pull-ups, but is beginning to potty train at home. Please take my child to the potty and provide assistance.
My child is fully potty trained. However, if he/she needs assistance, I give the staff permission to assist my child.
My child is fully potty trained and does not require assistance. I do not give the staff permission to help my child. I do realize by choosing this option, I will be contacted if my child has an accident and will need to come to the school to change my child.

Please specify your child's kind of diapers*

Cloth
Disposable

Registration Checklist

Please check the box next to each statement after reading.*

You may view the Parent Handbook and COVID guidelines on our website.

Select All
I understand that my registration fee, totaling $150.00, is non-refundable. I also understand that filling out this form and paying my registration fee does not guarantee a spot in the program. However, if a spot is not available for the beginning of the 2021/2022 school year, my check will be held and not deposited until a spot becomes available.
I understand that the registration form and fee are for the 2021/2022 school year only. Forms must be completed and fees must be paid for each school year.
I understand that registration is a “first come, first serve” basis. If my child is not placed in a class upon registration, he/she will be placed on a waiting list until a spot becomes available in the appropriate class.
I understand and have read the Parent Handbook, available on the website. I also understand that changes may be made throughout the school year and I will be kept informed of these changes.
I understand that Ball Camp Parents’ Day Out & Preschool is a Christ-centered program and that Biblical values will be taught.
I understand and have read the COVID Guidelines, available on the website. I also understand the changes may be made throughout the school year and I will be kept informed of these changes.
I understand that I will need to supply a copy of the child's birth certificate and up to date immunization records at Meet the Teacher.

Parent/Guardian Signature*

Date*

Registration Payment

Payment*

The registration fee is $150. Please note that you will be charged the $4.79 processing fee.

Price: $ 154.79

Total

$ 0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name