Mother's Morning Out | First Baptist Church

Name of Child*

Date of Birth*

Age As Of September 1*

ALL CHILDREN ENTERING THE THREE YEAR OLD CLASS MUST BE POTTY TRAINED

Attending On:*

Tuesday AND Thursday

Tuesday ONLY

Thursday ONLY

Address*

Father's Name/Guardian

Father's Phone( ) -

Father's Email

Father's Place of Employment

Mother's Name

Mother's Phone( ) -

Mother's Email

Mother's Place of Employment

Other Children in the Family and Age

Church Affliliation*

Child's Previous School Experience

Does your child make friends easily with:*

Other children?

Adults?

HAS YOUR CHILD HAD ANY CONTAGIOUS DISEASES, SERIOUS ACCIDENTS, OR OPERATIONS WE SHOULD KNOW ABOUT?*

ANY KNOWN ALLERGIES:*

Asthma?*

Yes

Pets?*

Yes

Frequent Nose Bleeds?*

Yes

Fears?*

ARE THERE ANY PHYSICAL REASONS FOR NOT PARTICIPATING IN NORMAL PRESCHOOL ACTIVITIES SUCH AS OUTDOOR PLAY?*

Any Special Instructions?

Information that will help us in conversation with your child (what they like, where grandparents live, ectc.)