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Early Education
Application
Let's do great things for your child together.
Fill out the form below to apply for UBC's Early Education program.
Date
First Name of Child
Last Name of Child
First Name Used at Home
Last Name Used at Home
Child's Date of Birth
Street Address
Country
City
State
Zip/Postal Code
Home Number
First Name of Father
Last Name of Father
Occupation of Father
Father's Work Phone
Father's Cell Phone
First Name of Mother
Last Name of Mother
Occupation of Mother
Mother's Work Phone
Mother's Cell Phone
Primary Email Address
What is the best way to contact you with information or reminders?
Home Phone
Cell
Text
Email
How did you hear about our preschool program?
Family Information
Does the child live with both parents?
Yes
No, only their mother
No, only their father
No, with neither parent
If with neither parent, then whom?
Are there any other circumstances we should be aware of?
Names and ages of siblings
Other people living in the home
Do you regularly attend church?
Yes
No
If so, where?
Social & Physical Growth
Describe your child's personality:
What are some of your child's favorite things?
Does your child have any special fears? If so, please list them.
Please list any allergies your child has:
Is there any other information you might add which would contribute to a better understanding of your child and their needs?
Emergency Information
Person authorized to act for parents in an emergency:
Phone Number
Physician's Name
Physician's Phone Number
Please indicate the program you are applying for. Programs are based on your child's age as of September 1st.
2-year old (2-days Th/F)
2-year old (3-days M/T's/W)
3-year old (3-days M/T's/W)
3-year old (5-day M-F)
4-year old (4-days M/T's/W/Thur)
4-year old (5-days M-F)
Kindergarten (5-days M-F / 8:30 - 12:30)
Registration Fee
Please either pay your one-time, nonrefundable $75 application fee online using the link below, bring it to the church office, or mail it to: Union Baptist Church 534 Rockwell Church Rd NE Winder, GA 30680 Attn: Early Education
If you have any questions, please contact the Early Education Dept. at (770) 867-7273.
Are you ready to submit? Please check over the information you have provided.
Yes
Submit
Want to pay the registration fee online?
Pay Registration Fee Online
