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UBC Early Education

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.

Today's Date

Child Information

First Name

Last Name

Date of birth

Address

Apartment

City

State

Postal / Zip Code

Gender

Male

Female

Contact Information

With whom does the child live? (check all that apply)

Father

Mother

Other Guardian

Father's Full Name

Father's Email

Father's Phone Number

Father's Occupation

Father's Work Phone Number

Mother's Full Name

Mother's Email

Mother's Phone Number

Mother's Occupation

Mother's Work Phone Number

Guardian's Name

Guardian's Relationship to Child

Guardian's Email

Guardian's Phone Number

Guardian's Occupation

Guardian's Work Phone Number

Does the child have a second guardian?

Yes

Second Guardian's Name

Second Guardian's Relationship to Child

Second Guardian's Email

Second Guardian's Phone Number

Second Guardian's Occupation

Second Guardian's Work Phone Number

What is your preferred method of contact?

Family Information

Are there any circumstances we should be aware of?

Names and ages of siblings, if any:

Other people living in the home:

Do you regularly attend church?

Yes

Where do you attend?

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:

Emergency Contact's Phone Number

Physician's Name:

Early Education Program

Please indicate the program you are applying for. Programs are based on your child's age as of September 1st.

How did you hear about our preschool program?

Registration Fee

Please either pay your one-time, nonrefundable $75 application fee online by clicking here, 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

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