Registration

Registration Form for God's Garden Preschool

STUDENT INFORMATION

First
Middle
Last

FAMILY INFORMATION

First
Last
Work Number
Cell Number
First
Last
Work Phone
Cell Number
City
State
Zip Code
City
State
Zip Code

MEDICAL INFORMATION/RELEASE

List any allergies and known accompanying reactions.
List any medications taken regularly and know adverse effects.

In the event a MEDICAL EMERGENCY arises and we are not able to contact the person(s) listed above, Believer's Fellowship personnel will, with your permission below, take appropriate action.

This action may include EMERGENCY ROOM treatment and/or AMBULANCE transportation.

Believer's Fellowship staff will only take this action if we are unable to contact person(s) listed above, and the emergency is beyond the scope of on site treatment.

authorize any emergency treatment as stated above.

This completed form/release will be sent to the Family Email Address listed above. This release is to be signed and dated when you meet with preschool staff.

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