2025-2026 Liberty Weekday Preschool Registration FormStudents must be 3 by 8/31/2025 to enroll in our PK3 program.Students must be 4 by 8/31/2025 to enroll in our PK4 program. We cannot make exceptions to this policy. Student's Information Student's Name * First Name Last Name Preferred Name Student's Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Student's Date of Birth * MM DD YYYY Student's Age * Student's Sex * Male Female Parent/Guardian Information Mother/Guardian's Name First Name Last Name Mother's Address (if different than student's address) Address 1 Address 2 City State/Province Zip/Postal Code Country Mother's Phone (###) ### #### Mother's Work Phone (###) ### #### Mother's Occupation Mother's Email Father/Guardian's Name First Name Last Name Father's Address (if different than student's address) Address 1 Address 2 City State/Province Zip/Postal Code Country Father's Phone (###) ### #### Father's Work Phone (###) ### #### Father's Occupation Father's Email Do you regularly attend church Yes No If so, where? Person responsible for tuition payments Who will usually pick up your student Please list the names (other than parents) to whom student may be released Please include name & phone number for each authorized person. Allergies Please list any known allergies: Student's T-Shirt Size 3T XS (4/5) S (6/7) M (8) L (10/12) Medical Release Emergency Contact (other than parents we always start with parents) As the parent and/or guardian of the registration applicant, I authorize treatment under the direction of any licensed physician in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment, or undue comfort if delayed. This authority is granted only after an attempt has been made to reach me first by phone at the number listed below. * Family Physician's Name & Phone Number * Hospital Preference * Photo Release During the school year, we take pictures of our special events and outings. In order to include pictures of your child on our website, literature or year-end slide shows, we must have a signed release from the child’s parent or legal guardian. Your child’s name will NOT be used in conjunction with their photo. A completed form must be turned in for each child enrolled in the preschool. * Yes, I grant permission for my child's photograph to be used for the purposes listed above. No, I do not grant permission for my child's photograph to be used for the purposes listed above. Parent's Digital Signature Thank you! Liberty Weekday PreschoolC/O Liberty Church1625 Ray Rd.Spring Lake, NC 28390
