To Pre-Register a child for SMART, please fill out and submit this form.

Child’s First Name*

A First name is required.

Child’s Last Name*

A Last Name is required.

Special Needs
or Allergies

Age*

An Age is required.Invalid format.The entered age is less than the minimum age required.The entered age is greater than the maximum age allowed.

Birthday*

Please select a MonthPlease select a Month Please select a DayPlease select a Day Please select YearPlease select a Year

Current Grade *

Please select a GradePlease select a Grade

Street Address*

An address is required.

Address (cont.)

City*

A City is required.

State*

A state is required.

Zip Code*

A Zip Code is required.Invalid Zip Code.

   

Primary Guardian

Required
Name (First, Last) A First Name is required. A Last Name is required.

Relation to Child

The Relationship is required.

Contact Number

A Phone Number is required.Invalid Phone Number.

   

Secondary Guardian

Optional
Name (First, Last)

Relation to child

Contact Number

   

Additional Emergency Contact

If other than above
Name (First, Last)

Relation to child

Contact Number

   

Release of Child

 


Please also allow the Person(s) listed below to pick up my child

Name (First, Last)
Name (First, Last)
Name (First, Last)

Notice: Students arriving without a guardian escort will be released at the end of the night
I Understand Please Acknowledge.

Joy Baptist Church will not sell or distribute any information collected using this form