New Student Enrollment

Student 1

*Last Name*First NameMiddle NamePreferred NameDate of BirthSuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelBlood TypeWho referred you to First Baptist Christian School?For incoming Kindergarten students, does your child currently attend First Baptist Pre-School?*AllergiesIEPFamily NameYes or NoSUFS ScholarshipFES UA

Student 2

Student 3

Student 4

Student 5

Primary Family Information

*Address Line 1Address Line 2*City*State*ZIP Code*Home PhoneHome Listed*Mobile PhoneMobile Listed

Parent 1 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGenderRace*Home E-Mail*cell Phonecell ListedCompany Name*Business Phone*ExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 2 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGenderRace*Home E-Mail*cell Phonecell ListedCompany Name*Business Phone*ExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Secondary Family Information

*Address Line 1Address Line 2*City*State*ZIP Code*Home PhoneHome Listed*Mobile PhoneMobile Listed

Parent 3 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGenderRace*Home E-Mail*cell Phonecell ListedCompany Name*Business Phone*ExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 4 Information

*Last Name*First NameMiddle NamePreferred NameDate of BirthMarital StatusSuffixTitleChurch AffiliationGenderRace*Home E-Mail*cell Phonecell ListedCompany Name*Business Phone*ExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Contact Information (Other than parents)

Contact 1

*Last Name*First Name*RelationIs Emergency ContactHome PhoneBusiness PhonePickup License*Mobile Phone*Pickup TagPickup Notes

Contact 2

Contact 3

Medical Contacts

*Physician*Physician Phone Number*Dentist*Dentist Phone NumberHospitalHospital Phone Number*InsuranceInsurance Phone Number*Policy Number

Finished

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Date of Last Upload: Thursday, April 18, 2024 Student Enrollment Form

Student 1

Primary Family Information

Parent 1 Information

Parent 2 Information

Secondary Family Information

Parent 3 Information

Parent 4 Information

Contact Information (Other than parents)

Contact 1

Medical Contacts