Child's Information:

Name (First, Middle, Last) (required)

Address Line 1 (required)

Address Line 2

City (required)

State (required)

Zip (required)

Birthday (MM/DD/YYYY) (required)

Age (required)

Gender (required)

T-Shirt Size (required)
XS (2-4)S (5-6)

Family Information:

Mother's Name (required)

Address (If different from child's)




Telephone Numbers:

Home (required)

Cell (required)

Work (required)

Employer (required)

Position (or previous work experience) (required)

Church Membership (required)

Email (required)

Father's Name (required)

Address (if different from Child or Mother's)



Zip Code

Telephone Numbers:

Home (if different from Mother's)

Cell (required)

Work (required)

Employer (required)

Position (required)

Church Membership (If different from Mother's)

Email Address (required)

Child's place in family (oldest, youngest, etc.) (required)

Other Children in Family (Name and Age) (required)

Previous Nursery or Kindergarten (required)

Is your child allergic to anything? If no, please type none. (required)

Any fears, nervous habits, etc., that might help us understand your child better? (required)

In which program do you wish to enroll your child? (required)
Two-Day OnesThree-Day OnesTwo-Day TwosThree-Day TwosFive-Day TwosTwo-Day ThreesThree-Day ThreesFive-Day ThreesThree-Day FoursFive-Day FoursKindergarten

If you are enrolling in a Two-day program, which two days of the week do you plan to have your child attend? MondayWednesdayFriday

Music or Lunch bunch? ($25 per month.) (Music bunch only 3K and 4K) (Please choose only one.) MusicLunch BunchNeither

My child has my permission to go on all field trips organized by Calvary Baptist Church Kindergarten during the school year he or she is enrolled. I understand that I will be notified prior to all trips. Children will be transported on the church bus with a licensed driver and chaperones. (required)

I would like to enroll my child in Calvary Baptist Kindergarten because...

Please list two other contacts other than you who can be reached if needed in an emergency. (Name and Phone) (required)

Hospital Preference (required)

Preferred Email(required)

Checking the below box acts as a signature authorizing that the above information is true. (required)

Date signed (required)