Register Here – Bakerstown Presbyterian Children's Center

Mother's First Name

Mother's Last Name

Mother's Cell Phone

Mother's Email

Father's First Name

Father's Last Name

Father's Cell Phone

Father's Email

Name of Primary Contact Person(Required)

Email Address of Primary Contact Person(Required)

Address of Primary Contact Person(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

In which school district do you reside?(Required)

How did you first hear about Bakerstown Presbyterian Children's Center?

Word of Mouth

Social Media

Other

How Many Children Would You Like to Register?(Required)

Information for Child 1:

First Name of Child 1(Required)

Last Name of Child 1(Required)

Gender(Required)

Boy

Girl

Birth Date(Required)

Age of Child 1 (as of Sept 1, 2024)(Required)

Does this child reside at the address of the primary contact person listed above?(Required)

Yes

Address Where This Child Resides

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does this child have any allergies and/or medical conditions? (seasonal, food, medications, etc.)(Required)

Yes

If you answered "Yes" to the previous question, describe your child's allergies and/or medical condition.

Please list any custody issues:

Does this child have any special needs, receive any services (eg speech) or require any accommodations?(Required)

Yes

Please explain below

Rank Your Choice of Class Times for Child 1:

BPCC adheres to the Pine-Richland School District birthday deadlines for enrollment. Each child must be 2, 3, 4, or 5 years of age by September 1, 2023 to be enrolled in the corresponding class. Please indicate your 1st, 2nd and 3rd choice preferences using the drop-down options below.

First Choice (Child 1) – 2s

Second Choice (Child 1) – 2s

Third Choice (Child 1) – 2s

First Choice (Child 1) – 3s

Second Choice (Child 1) – 3s

Third Choice (Child 1) – 3s

First Choice (Child 1) – 4s

Second Choice (Child 1) -4s

Third Choice (Child 1) – 4s

First Choice (Child 1) – Pre-K

Information for Child 2:

First Name of Child 2

Last Name of Child 2

Gender

Boy

Girl

Birth Date

Age of Child 2 (as of Sept 1, 2024)(Required)

Does Child 2 reside at the address of the primary contact person listed above?

Yes

Address Where This Child Resides

Street Address Address Line 2 City State ZIP Code

Does Child 2 have any allergies and/or medical conditions? (please include seasonal, food, medications)(Required)

Yes

If you answered "yes" to the previous question, please describe your child's allergies and/or medical condition.

Please list any custody issues:

Does Child 2 have any special needs, receive any services (eg speech) or require any accommodations?

Yes

Please explain below

Rank Your Choice of Class Times for Child 2:

First Choice (Child 2) – 2s

Second Choice (Child 2) – 2s

Third Choice (Child 2) – 2s

First Choice (Child 2) – 3s

Second Choice (Child 2) – 3s

Third Choice (Child 2) – 3s

First Choice (Child 2) – 4s

Second Choice (Child 2) -4s

Third Choice (Child 2) – 4s

First Choice (Child 2) – Pre-K

Information for Child 3:

First Name of Child 3

Last Name of Child 3

Gender

Boy

Girl

Does Child 2 have any allergies and/or medical conditions?(Required)

Yes

If you answered "yes" to the above question, please describe your child's allergies and/or medical condition.

Birth Date

Age of Child 3 (as of Sept 1, 2024)(Required)

Does Child 3 reside at the address of the primary contact person listed above?

Yes

Address Where This Child Resides

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list any custody issues:

Does Child 3 have any special needs, receive any services (eg speech) or require any accommodations?

Yes

Please explain below

Rank Your Choice of Class Times for Child 3:

First Choice (Child 3) – 2s

Second Choice (Child 3) – 2s

Third Choice (Child 3) – 2s

First Choice (Child 3) – 3s

Second Choice (Child 3) – 3s

Third Choice (Child 3) – 3s

First Choice (Child 3) – 4s

Second Choice (Child 3) – 4s

Third Choice (Child 3) – 4s

First Choice (Child 3) – Pre-K

Submit Your Information

Once you submit the information, you will be directed to a payment page to make a deposit. (Your registration will not be complete until you submit the payment.)

Phone

This field is for validation purposes and should be left unchanged.

Child Registration Form

Information for Child 1:

Rank Your Choice of Class Times for Child 1:

Information for Child 2:

Rank Your Choice of Class Times for Child 2:

Information for Child 3:

Rank Your Choice of Class Times for Child 3:

Submit Your Information