King's Park Preschool Registration Application (2025-2026)

A Ministry of King’s Park International Church
2025-2026 School Year

Children are accepted to King's Park Preschool on a first come, first serve basis. Your child’s enrollment is confirmed upon receipt of this completed form and the registration fee. We will contact you to confirm your child’s enrollment in the program.

Your name *

Last name

Email address *

Child's Information

Only one child per registration, please.

First Name: *

Last Name: *

Birthdate: *

Gender: *

Lives With: *

Mom & Dad

Mom

Dad

Other

Sibling Names and Ages: *

Food Allergies: *

Yes

Medical Conditions: *

Yes

Potty Training: *

Is your child potty trained?

Yes

In process

Details:

Please give us any information concerning your child which would be helpful in his/her preschool experience (play, likes and dislikes, personality, temperament, eating habits, etc.).

Parent/Guardian Information

First Name: *

If you are the one filling out this form, please put your own information here:

Last Name: *

Relationship to Child: *

Mom

Dad

Other

Phone number *

Phone type

Address *

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

First Name:

Please put the information of the other parent/guardian here.

Last Name:

Relationship to Child:

Mom

Dad

Other

Email:

Phone Number:

Address:

Fill out only if address is different than first parent/guardian listed above.

Emergency Contact Information

Please list 1-2 people below who are DIFFERENT than the parent/guardians listed above.

First Name: *

Last Name: *

Phone Number: *

First Name:

Last Name:

Phone Number:

Other Authorized Pick-Up Persons

In order to provide the safest environment possible for your child, we ask that you list anyone other than those persons listed above to whom we may release your child.

First Name:

Last Name:

Phone Number:

First Name:

Last Name:

Phone Number:

Agreements

Medical Authorization: *

I understand that I will be contacted immediately if any medical issues occur. I agree that King's Park Preschool staff may call 911 in the case of emergencies. I understand that all medical costs incurred are my responsibility. I authorize operator to transport my child to an appropriate medical resource in the event of an emergency. I release and forever discharge King's Park Preschool employees from and against any and all liability incurred as a result of any act they may perform on behalf of my child (i.e. CPR).

Yes

Change of Information: *

I agree to immediately notify King's Park Preschool of any changes to the information provided on this application. This includes addresses, phone numbers, medical information, emergency contacts, etc.

Yes

Photo Release: *

I grant my expressed permission for King's Park Preschool to exhibit photographs, videos, and/or likenesses of the above named student. Use of images may include the King’s Park International Church website, the King's Park Preschool Facebook page, social media and other publications. Names of the photographed children would not be included.

Yes

Church Affiliation: *

King's Park International Church

Other

Electronic Signature of Parent/Guardian

First Name: *

Last Name: *

Date: *

Payment

Non-refundable Registration Fee: $100 *

You can pay online here: https://kingspark.org/KPPRegistration

I will pay in full using a credit/debit card.

I will pay in full within 7 days using cash/check.

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King's Park International Church
info@kingspark.org
9195446304