Skip to content
615-814-2207 | 537 Franklin Rd Building C, Franklin, TN 37069
Facebook
Instagram
Staff Portal
Home
Staff
Registration
Make a Payment
Extended Fun
Tuition
Safety Fee
4+ Year Old Info Form
4+ Years Child Info Form
This form is for children born between 1-1-2020 through 9-30-2022
Contact Information
Your Name
(Required)
First
Last
Your Phone
(Required)
Your Email
(Required)
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Child's Information
Child's Full Name
(Required)
First
Last
Does your child have a nickname or preferred Name?
(Required)
Yes
No
Child's Nickname/Preferred Name:
Child's Birthdate
MM slash DD slash YYYY
Child's Age:
(Required)
Child's Gender
(Required)
Male
Female
Child's Shirt Size:
(Required)
If any, what preschool/daycare did your child previously attend?
Guardian 1's Information:
Guardian 1's Name
(Required)
First
Last
Guardian 1's Address
(Required)
Street Address
Guardian 1's Phone
(Required)
Guardian 1's Place of Work
(Required)
Guardian 2's Information:
Guardian 2's Name
(Required)
First
Last
Guardian 2's Address
(Required)
Street Address
Guardian 2's Phone
(Required)
Guardian 2's Place of Work
(Required)
Family Information
Primary language used at home:
(Required)
Do you have a current domestic relations order or parenting plan governing custody of the child?
(Required)
If the family has a domestic relations order or parenting plan governing custody or care of the child, we must have a copy of this order or parenting plan. If for any reason the noncustodial parent is not allowed visitation rights and does not have the right to remove the child from school, we must have a legal document from the custodial parent to support this order. These documents must be received by your child's school before he or she will be enrolled. You are responsible for notifying the school if these plans change. Please be sure any legal documents pertaining to child custody or care on file with your child's school are current at all times.
Yes
No
Do both parents have custody?
(Required)
Yes
No
Who does the child primarily live with?
(Required)
List any sibling name(s) and age(s)
Add
Remove
Throughout the day, we offer three snacks. Please indicate below if your child can have the following snacks:
Rold Gold Pretzel Sticks
(Required)
Yes
No
Goldfish Crackers
(Required)
Yes
No
Veggie Straws
(Required)
Yes
No
Traits & Personality
Please describe your child's personality:
Please list your child's strengths:
Please list your child's weaknesses:
Does your child use:
Check all that apply.
Paint
Crayons
Pencil
Markers
Chalk
Behaviors
If applicable, please list any behavior habits your child may have here:
Does your child have any fears? If yes, please list them here:
Does your child cry easily?
Yes
No
What causes your child to cry?
Is it easy for your child to be separated from parents/guardians?
Yes
No
What types of discipline are used in the home?
Please list any specific interests or toys your child may have:
Medical Information
By voluntarily enrolling my child in ClearView Prep Preschool, I acknowledge and agree that I am assuming the risk of my child or myself possibly contracting any/all viruses (including coronavirus, flu, illness, etc). Further, I acknowledge and agree that on my behalf and on behalf of my child, I am voluntarily waiving and releasing any claim of liability against ClearView Prep Preschool and ClearView Baptist church should my child or I contract any virus, flu, illness, etc. as result of participating in CV Prep activities. Further, I expressly agree to hold ClearView Prep Preschool (ClearView Baptist Church) harmless should I and/or my child contract viruses, flu, illness, etc. as result of my child's participation in CV Prep activities, and to indemnify CV Prep Preschool (ClearView Baptist Church) against any claims asserted by or on behalf of my child.
(Required)
I consent
I withhold consent
Consent to Treat:
(Required)
I consent
I withhold consent
List any/all allergies here:
(Required)
Does your child take any medication on a regular basis? If yes, please list below:
Does your child have an EpiPen? If yes, CV Prep will need to have an extra one. Doctor's instructions must be included.
Yes
No
If your child has ever been treated professionally for medical, behavioral, or psychological reasons, please list why below:
Has your child ever been diagnosed with a disability or special need? If yes, please list below:
Is there anything in your child's past medical history which the school should be made aware of? If yes, please list below:
Emergency Contact Name
First
Last
Emergency Contact Phone Number
Doctor's Name, Practice Name, and Office Phone Number:
Dentist's Name, Practice Name, and Office Phone Number:
Health Insurance Company and Policy Number:
Hospital of Choice:
Medical Concerns:
If any, what church does your family attend?
I understand that ClearView Prep Preschool is NOT required to be licensed by the state as a Child Care Agency.
Yes
No
Guardian Signature (By typing your name here, we recognize this as an electronic signature.)
(Required)
What is Today's Date?
(Required)
MM slash DD slash YYYY
Δ
Page load link
Go to Top
