Forest Hills Baptist Church Mother's Day Out

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Kid’s Quest Registration Form $25.00 Registration Fee required to reserve spot 117 Marlin Road, White House, TN 37188

Date Full name of Child (Last) What does child like to be called?

M/ F (First)

(Middle) Child’s Birthday (M)

(D)

(Y)

Address (Street)

(City)

(State)

(Zip)

Name of Mother Home Phone Cell Phone Employer____________________________________________________________________________ Work Phone Work Hours Email:_______________________________________________________________________________ Name of Father Home Phone Cell Phone Employer____________________________________________________________________________ Work Phone Work Hours________________________________ Email:_______________________________________________________________________________ Where does your family attend church? Member? Yes _____No Name of persons authorized to act for parents in case of emergency: Family Member Name: Address: Friend’s Name: Address: Other children in the family: Name Age

Phone Phone

Does your child have any unusual health conditions, such as allergies, asthma, epilepsy, etc.? If none, please write none.___________________________________________________________________________ To meet your child’s individual needs, please give us any helpful information: _____________________ ____________________________________________________________________________________ 2012 Kid’s Quest Children who have completed Kindergarten - 5th Grade may enroll in Kid’s Quest. Final enrollment will be based on space availability. Note: $25 non-refundable registration fee is due upon enrollment. My child has completed the

grade. Full-time enrollment ______ Daily _______