Living Word Church - Enrollment Form

Enrollment Form

Name of Child

Birthdate

Parents

Best Number to reach you

Alternate Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Emergency Contact if you cannot be reached:

First Name

Last Name

Phone Number

Other people authorized to pick up your child:

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

I release the preschool from any liability associated with activities my child will be involved in while attending.

Signature