ENROLLMENT FORM
After submitting this online form, in order to complete the enrollment process, mail or bring by the $60 non-refundable enrollment fee to:
First Baptist Church of Lamar, PO Box 426,
1301 E. 6th Street, Lamar, MO  64759
Make checks payable to FBC’s & 123’s

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CHILD'S NAME (First, Middle, Last) *
Level Entering Into *
BIRTH DATE *
MM
/
DD
/
YYYY
*
MAILING ADDRESS *
MOTHER'S NAME
MOTHER'S ADDRESS (only if different)
MOTHER'S PHONE NUMBER
MOTHER'S EMAIL ADDRESS
FATHER'S NAME
FATHER'S ADDRESS (only if different)
FATHER'S PHONE NUMBER
FATHER'S EMAIL ADDRESS
SIBLINGS (Names & Ages)
NAME OF EMERGENCY CONTACT OTHER THAN PARENT *
RELATIONSHIP OF EMERGENCY CONTACT *
EMERGENCY CONTACT PHONE NUMBER *
EMERGENCY CONTACT ADDRESS *
PLEASE LIST ALL PEOPLE (other than parent) WHO ARE ALLOWED TO PICK UP YOUR CHILD FROM PRESCHOOL *
HOME CHURCH (if applicable)
PLEASE TELL US ABOUT ANY ALLERGIES, SPECIAL MEDICAL CONDITIONS, (Including Chronic Health Problems or Disabilities) SPECIAL MEDICATIONS, AND/OR RESTRICTIONS:
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