FIRST METHODIST SCHOOL

403 South Main (Mailing Address)

Duncanville, TX 75116

Phone 972-298-5890 Fax 469-533-2372

Child’s Name ___________________________________________ M/F ___ Birthdate __________________

Address ____________________________________________________________________________________

City __________________________________ Zip _____________ Phone ____________________________

Father’s Name ___________________________________ Mother’s Name ____________________________

Father’s Occupation _______________________________ Business Phone ____________________________

Mother’s Occupation ______________________________ Business Phone ___________________________

Cell phones or pagers Mom __________________________________ Dad ____________________________

Brothers/Sisters(names & ages) _________________________________________________________________

Church Affiliation ___________________________________________________________________________

I understand that my child will be in school (please select all that apply)

MON-FRI (K & 4 yr olds) MWF (3 & 4 yr olds) T/TH (3 & 4 yr olds)

M/W School (1 & 2 yr olds) T/TH School (1 & 2 yr olds)

Friday Fun (1 & 2 yr olds) Summer Fun (M/W June & July 1–10 yr olds)

Is there anything significant which we should know that might affect your child’s physical or emotional well-being? ______________________________________________________________________________________

Special problems, needs, or allergies of child: _____________________________________________________

____________________________________________________________________________________________

In what kind of situation will your child need the most help? ________________________________________

I understand that special problems or occurrences, including communicable diseases, will be brought to the attention of the parents. I also understand that staff members will be available for conferences upon request.

Child’s Physician _______________________________________ Phone ______________________________

Address _________________________________________________ City _________________ Zip ________

In case of emergency please list 2 people to notify if we cannot reach either parent:

NAME ADDRESS PHONE NUMBER

1.__________________________ _____________________________________________ _________________________

2.__________________________ _____________________________________________ _________________________

In order to meet all legal requirements, I hereby authorize any representative of First Methodist School to give consent for any and all necessary emergency medical care for my child while said child is in their care.

I hereby give my permission for my child to go on all field trips with his class at First Methodist School in private or public conveyances, if accompanied by adults. I do hereby release First United Methodist Church & School from any and all claims that might arise while my child is in school or on a trip sponsored by First Methodist School.

I AGREE TO THE ABOVE STATEMENTS IN TOTAL: __________________________________________

Signature of parent

Date: __________________________________________

PLEASE RETURN ALL COPIES

DATE OF ENROLLMENT: (For office use only)