Christ Church Children’s Center 2011/2012 Registration
Form
Child’s Name(s)__________________________
Birth Date____/____/____ Age_____ Male ___ Female ___
__________________________ ____/____/____ Age_____ Male
___ Female ___
__________________________ ____/____/____ Age_____ Male ___
Female ___
Parents/Guardians Name:
Mother_____________________________ Father_________________________
Address:
_____________________________________ Telephone: _____________________________
______________________________________
Please
check all that apply:
Before School Care
- 6:30 a.m.-9:00 a.m. After School Care - 3:30
p.m.-6:00 p.m.
Three Days _____ Three
Days _____
Five Days _____ Five
Days _____
Before and After School Care Early Learning Program
Three
Days _____ Three
Days _____ 9-11:30 am
Five
Days _____ Five
Days _____ 9-11:30 (M-F)
All Day Care -
6:30 a.m.-6:00 p.m.
Three
Days _____
Five
Days _____
Twos ____ Threes ____ Fours ____ School-Age
____
Start Date
________________________________
Parents Signature
___________________________________________ Date __________________________
Please
enclose a non-refundable registration fee of $75.00 for one child, $100.00
family, made
payable to Christ Church Children’s Center.
Mail registration form, contract and fee to: Christ Church Children’s
Center,
Ask
about our referral rewards program!
Do you have a church affiliation? Join us for Sunday services, 8:15 a.m. -
Contemporary Service - 9:15 a.m. -
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