FBA Preschool Registration Form

Child’s shirt size

2024-2025

*Check or cash only accepted for registration payment

Child’s Full Name

Name child uses

Birthdate

Male

Female

Age as of September 1

Parent #1 email

Parent #2 email

Street Address

City

ZIP / Postal Code

Mother’s Name

Place of Employment

Work Phone

Cell

Father’s Name

Place of Employment

Work Phone

Cell

Child resides with:

Both Parents

Mom

Dad

Other, please specify whom

If there is a separation or divorce in the family, please complete the section below:

If separated or divorced, with which parent does the child reside

Please describe the custody agreement regarding picking the child up from school:

*Please note that a copy of the custody papers must be on file in student’s permanent record. This child may NOT be released to the following (due to custody arrangements):

Medical Information:

Name of Pediatrician

Office Phone

Any Known Allergies:

Is your child taking any medication on a regular basis?

If yes, please note here:

Does your child have any health concerns we should be aware of?

I hereby give permission for the staff of First Baptist Academy and/or any necessary medical personnel to meet the needs of my child in the event of an emergency.((Initial here)

Does your family have a home church?

If so, name of church

Would you like some information about the First Baptist Church of Covington?

The following person(s) have my permission to pick up my child from preschool or in the event of an emergency and the parent/guardian cannot be reached. A picture I.D. will be required.

Name

Phone/Cell

Relation to child

Name

Phone/Cell

Relation to child

Name

Phone/Cell

Relation to child

Name

Phone/Cell

Relation to child

Media Agreement:

Please check:YesNofor permission to include address/phone on class list

Please check:YesNofor permission to use photos of child for use in ads/social media

I understand that it is the policy of FBA to give no refunds or transfer registration fees.

Parent Signature

Date

Please note upcoming fees and payments:

August- First month tuition + one time FACTS service fee (yearly payment plan $20 fee, Bi-annually $30 fee, and monthly payment $50 fee)

September- Second month tuition + school/curriculum fee (a one-time fee for the year)

October through May- Tuition payment only

While there are several times throughout the year when school is closed, tuition is based on the number of days throughout the entire school year. The monthly tuition option is for the convenience of our families and is NOT based on the number of days per month that your child attends school.