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Student Enrollment Form

Please complete the Student Enrollment Form below. Please note, this form needs to be completed for EACH child enrolled in the Merry Hearts Preschool. If you have questions please contact Scarlett Keith.

Student Information

Child's full name

Preferred name

Birthday

Month

Day

Year

Gender

Male

Female

Date

Month

Day

Year

Street address

City

State

Zip code

Parent/Guardian Information

Parent/Guardian 1

Relationship to child

Employer

Work phone

Cell phone

Parent/Guardian 2

Relationship to child

Employer

Work phone

Cell phone

Emergency Contact

Emergency contact name

Relationship to child

Cell phone

Work phone

Release to a Non-parent

To whom may your child be released other than a parent? Please list their name(s), relationship and phone numbers.

Release to Non-Parent

Medical, Allergies & Other Information

Please list any other information concerning your child which will be helpful to us.

Medical issues, allergies, fears, eating habits, etc.

Physicians's Name

Physician's Phone Number

Your signature on this form verifies that the information given is correct and that you give permission to the staff of Merry Hearts Preschool to provide the necessary care for your child, either on site or at the nearest medical facility in the event of a medical emergency. In the event of such an emergency we will make every effort to reach you or your emergency contact.

Your Signature

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The Merry Hearts

Preschool at Bethesda Presbyterian Church

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Student Enrollment Form

Student Information

Parent/Guardian Information

Emergency Contact

Release to a Non-parent

Medical, Allergies & Other Information

< Back to School Forms