Preschool Registration

There is no fee to be on the Preschool wait list. Families will be contacted as space becomes available.

(* Required)

Child's Name:*
First Last

Gender?*
Male
Female

Child's date of Birth?*
Month
Day
Year

Are you a Providence Baptist Church member?*
Yes
No

Primary Parent Name:*
Prefix First Last

Relationship to Child?*

Primary Contact Phone:*

Primary Email:*
Enter Email Confirm Email

Secondary Parent Name:
Prefix First Last

Relationship to Child?

Secondary Contact Phone:

Secondary Email:
Enter Email Confirm Email

Primary Address:*
Street Address Address Line 2 City State Zip Code Country

Age Group:*
Please select the age / group of your child, as of August 31, 2022.

Days of week requested:*