Preschool Application Apply Now Student's Full Name * Name Preference * (For nametags and learning to write) Birthdate * MM DD YYYY Age * Select 2 3 4 Sex * Select Male Female Social Security Number OPTIONAL - provide to office Parent's Social Security Number OPTIONAL - provide to office Applying For... * Select K-3 Half Day (MWF) K-3 Half Day (5 Days) K-3 Full Day (MWF) K-3 Full Day (5 Days) K-4 Half Day (MWF) K-4 Half Day (5 Days) K-4 Full Day (MWF) K-4 Full Day (5 Days) Father's Name * First Name Last Name Mother's Name * First Name Last Name Church Membership, City * Home Address * (Of parent they live with during the school week) Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone (###) ### #### Mother's Cell Phone * (###) ### #### Father's Cell Phone * (###) ### #### Mother's Work Phone (###) ### #### Father's Work Phone (###) ### #### Mother's Email Father's Email Mother's Employment, City Father's Employment, City How Did You Hear About FBCS Emergency Contact #1 * We will always contact the parent's first. If we are unable to reach you, please list relatives or friends we can contact. Emergency Contact #2 * Primary Physician * One of the entrance requirements for our preschool students is that they be potty trained. This includes being able to clean themselves afterwards. * Is your child potty trained? Select Yes No If no, will they be potty trained before school begins? Select Yes No Medical Information Please list prescription medications that are taken regularly (Please include any OTC medicines, such as Miralax, which a doctor has recommended) Please list any allergies especially food or medicine: We give permission for the following medications to be given from the office: Children's Tylenol Tums Cough Drops Thank you!
