King’s Kids Preschool ~ 2023-2024
Please fill out this form and click submit.
Child's Infomormation
Name
*
Name child is called at home?
*
Date of Birth
*
Gender
*
Please select all that apply.
Male
Female
Select the (2 or 3) days your child plans to attend.
*
Please select all that apply.
Tuesday
*Wednesday
Thursday
Age as of 9/1/23
*
Child’s Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent Information
Mother’s Name:
*
Mother's Cell Phone
*
Mother’s Employer
*
Mother's Work Phone
*
Parent Email
*
This address will receive a confirmation email
Father’s Name:
*
Father's Cell Phone
Father’s Employer:
Father's Work Phone
Child lives with (check one):
*
Please select all that apply.
Parents
Mother
Father
Other
Brothers and sisters (please list names used by child): Names and ages.
*
Church Home:
*
Is child completely potty-trained? (required to enter three-year old or four-year old class)
*
Please select all that apply.
Yes
No
If not, do you anticipate this happening before school begins?
*
Please select all that apply.
Yes
No
Please list any allergies, sensitivities, chronic illnesses, learning disabilities, etc.:
*
Emergency Contacts (List 4)
1. Name
*
Relationship to child
*
Phone
*
2. Name
*
Relationship to child
*
Phone
*
3. Name
*
Relationship to child
*
Phone
*
4. Name
*
Relationship to child
*
Phone
*
Doctor’s name:
*
Is your child up-to-date on all necessary immunizations? (The State of Alabama Department of Public Health requires that a current immunization record be kept on file for all students at King’s Kids. Please submit one by the first day of school if you have not already done so.)
*
Please select all that apply.
Yes
No
Please list any information such as fears, eating habits, favorite activities or special family situations that you feel would help us better care for your child:
*
Please list those other than yourself who are authorized to pick up your child from King’s Kids:
*
If your child has a special friend they would like to have in their class or if there is a teacher you prefer, we will make every attempt to honor your request. Please specify:
*
****IN CASE OF EMERGENCY, I GIVE MY PERMISSION FOR MEDICAL CARE TO BE PROVIDED TO MEET THE NEEDS OF MY CHILD****
*
Signature
*
Date
*
You will receive an email shortly from lhodges@woodmontbaptist.org with payment information.
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