GCS Preschool Enrollment
2022-2023 School Year
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Child's Name *
Nickname, if any
Date of Birth *
MM
/
DD
/
YYYY
Home Address *
Parent/Guardian #1 Name: *
Parent/Guardian Address, if different from child
Home Phone
Work Phone
Cell Phone *
Email Address *
Parent/Guardian #2 Name
Parent/Guardian Address, if different from child
Home Phone
Work Phone
Cell Phone
Email Address
Custody Concerns/Persons who DO NOT have permission to pick up from school
Special instruction for reaching parent/guardians
Primary Emergency Contact (other than parent/guardian) *
Phone Number *
Relationship to child
Secondary Emergency Contact (other than parent/guardian)
Phone Number
Relationship to child
Regular Medications
Any known allergies?
Any special health conditions, serious illnesses, or hospitalizations.
Is your child potty trained and able to independently use the bathroom?  (2 year old students may skip this question.)
How can we best support your child this year?
I/We agree that Galilee Christian School, Galilee United Methodist Church, and the staff working in the program shall not be held liable in case of illness or injury of my/our child while in attendance in the facility, upon the grounds, or while participating in a scheduled field trip or extra-curricular activities.  Galilee Christian School is covered through the public liability insurance of Galilee United Methodist Church.  In case of illness or injury, parent will be notified immediately and will be expected to arrange for pick-up of the child as soon as possible. *
I/We agree to notify the school immediately after the diagnosis of any communicable disease in any member of our household. *
I/We give consent for my/our child to take part in field trips or excursions under proper supervision as well as all normal classroom and playground activities. *
I/We agree that in case of injury, emergency medical care and/or emergency medical treatment may be given as deemed reasonable and appropriate under the circumstances, notwithstanding failed attempts to contact me/us immediately. *
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