Gospel Tabernacle Academy
Application for Daycare Program
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Email *
Student Information *
Full Name of Child
Age *
Birthdate *
MM
/
DD
/
YYYY
Gender *
Social Security # *
Address, City, State, Zip Code *
Phone # *
Does Your Child have Any Allergies? *
Specify what type of allergy (Select all that apply) *
Required
If yes, please describe (lactose, nuts, etc.) *
Is your child on any continuous medication? *
If yes, please describe
Please give any information concerning your child which will be helpful in his/her experience in a group setting.
Such as eating, play, and sleeping habits, likes, dislikes, and fears.
Photo/Video Release Form *
GTA has permission to use my child's photograph and/or video images publicly to promote GTA and advertise school activities.  I understand that the images may be used in print publications, online publications, presentations, websites, and social media.  I also understand. that no royalty, fee, or other compensation shall become payable to me by reason of such use.  
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