Parent/Guardian #1 Information
Please note: Cell Phone Carrier is used for emergency texts.
* First Name 
* Last Name 
* Relation to Child 
* Email 
* Send to this email 
* Address 
* City 
* State 
* Zip 
  Cell Phone 
  Cell Phone Carrier    Home Phone 
  Employer   Position 
  Work Phone 
  Phone for Class Roster 


School/Class Roster Information
     
You have my permission to publish the following information pertaining to my child(ren) in a Class or School Roster. You will have the opportunity to make changes after school starts.

Parents' Names
Parent/Guardian #1 Email
Parent/Guardian #1 Address
Parent/Guardian #1 Phone for Roster
  
*  


Parent/Guardian #2 Information
  First Name   Last Name 
  Relation to Child    Email 
  Send to this email    Address 
  City   State 
  Zip   Cell Phone 
  Cell Phone Carrier    Home Phone 
  Employer   Position 
  Work Phone 


Emergency/Pick-Up Information (other than parents)
     
Contact #1  
* First Name 
* Last Name 
* Relation to Child 
* Authorized Pickup 
* Main Phone 
  Alternate Phone 
     
Contact #2  
  First Name   Last Name 
  Relation to Child    Authorized Pickup 
  Main Phone 
  Alternate Phone 


Additional Information
* 
* Are you an ACTIVE member  
of West Hills Baptist Church?

 
  Referred By 


Medical Information
     
Physician  
  Name   Phone 
     
Dentist  
  Name   Phone 
     
Insurance Coverage  
  Carrier   Group # 
  Policy # 


In Case of Emergency
Take child to...
     
any licensed physician?  
     
which emergency hospital?  
         


Registered Child(ren)
To register your child(ren), please click the Add a Child button.



Privacy Policy
We keep your personal information private and secure.

Contact Us
West Hills Baptist Preschool & Kindergarten
409 N. Winston Road, Knoxville, TN 37909
(865) 690-4251
preschool@wherechildrengrow.org

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