Registration Form -Lakewood Baptist Child Development Center

Lakewood Baptist Child Development Center

REGISTRATION FORM FOR:

SUMMER 2004 & THE ‘04-‘05 SCHOOL YEAR

RETURN THIS FORM TO LAKEWOOD BAPTIST

Child's Name:______________________________

Age: __________ Birth Date: 00 / 00/ 19

Parent's Name: ____________________________

Phone Number: _______________________

Address: _________________________________

City:_________________________________

Please indicate if you need bus service to and from PRE-SCHOOL (City of Lakewood ONLY)

Name Contact person:_______________________________ Yes _____ No ____

Bus Stop Address: _________________________________ Phone Number ________________

Bus service is limited and will be taken on a first-come/ first serve basis!

Please Check All programs you are registering for:

3-5 Year Olds

Full Day Pre-School Enrichment

2 Day 3s Enrichment (M&T)

3 Day 3s Enrichment (W-F)

4 Day 4s Enrichment (M-TH)

Summer Program (Pre School)

School Age (K-5)

Before / After AM Kindergarten (PM Care)

Before / After All Day Kindergarten

Before / After Grade School (Grades 1-5)

Summer Program (Kindergarten)

Summer Program ( School-Age)

We are unable to provide MORNING care for children in PM Kindergarten.
We do not provide transportation to Harrison, McKinley, All Middle Schools, & Project 1-2-3.

School Attending:

$50 Non-Refundable Registration Fee due with form.

My child will also be attending the Summer Camp Program. Please Check one:

Please check your method of payment:

Signed: ___________________________________________________________________________