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*
MM slash DD slash YYYY
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?*
- Family/Friend
- Internet
- Facebook
- Church Sign
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*
MM slash DD slash YYYY
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*
MM slash DD slash YYYY
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*
MM slash DD slash YYYY
Registration Payment
Payment*
The registration fee is $150. Please note that you will be charged the $4.79 processing fee.
Price:
Total
$ 0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Name	Age

PDO & Preschool Program Registration

Parent/Guardian Information

Personal Information

Allergy & Medical Information

Permission for Photographs

Potty Training

Registration Checklist

Registration Payment