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Saint Paul Preschool
8436 Kraft Ave Caledonia, MI 49316
616-891-1821
Registration Form
Child's Name________________________________Date_____________
Nickname__________________Male__Female__Date of Birth_________
Street Address_____________________________Home Ph#__________
City____________________State______________Zipcode____________
Mother's Name_______________________________________________
Mother's address if different than child's___________________________
___________________________________________________________
Mother's Employer_____________________Work Ph#_______________
Father's Name_______________________________________________
Father's address if different than child's____________________________
___________________________________________________________
Father's Employer___________________Work Ph#__________________
Does you chld have any physical, medical conditions or allergies?
___________________________________________________________
___________________________________________________________
Is your child on any medication? _________________________________
____________________________________________________________
Please list any one that you give your permission to pick up your child from St. Paul Preschool. St. Paul Preschool will NOT release your child to anyone that is not on this list.
Name_____________________________Phone____________________
Name_____________________________Phone____________________
Name_____________________________Phone____________________
Name_____________________________Phone____________________
Name_____________________________Phone____________________
In case of emergency, please indicate preferences for:
Hospital__________________________Phone_____________________
Doctor___________________________Phone______________________
Dentist__________________________Phone_______________________
Relative/Family Friend_____________________Phone_______________
If the doctor and/or dentist and parent are not available in any amergency, I authorize the Preschool Director to obtain the necessary care for my child. I also affirm that my child is physically able to participate in all the preschool activities.
Parent's Signature_______________________________Date__________
"Train a child in the way he should go,
and when he is old
he will not turn from it."
Proverbs 22:6
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