Severna Park Baptist Church
Wednesday, February 22, 2012
Growing Godly Generations

Registration Form 2012-2013

    
      Print out form and mail or deliver to Judy Myer at 506 Benfield Road, Severna Park, MD 21146 
 

 REGISTRATION APPLICATION
Severna Park Baptist Church-Weekday Early Education Center
506 Benfield Road, Severna Park, Maryland 21146
410-647-8162
 
 
OFFICE USE ONLY -CLASS: ___________________________________________________________
 
Date of Application ____________________________________________________________________
 
Child's Name_________________________________________________________________________
                   (last)                           (first)                          (middle)            (name used)
 
Sex_____  Date of Birth______/______/______    Place of birth______________________________
(Must be 2 - 3 - 4 by SEPTEMBER 1st)
 
Address_____________________________________________________________________________
                    (street)                                  (city)                                   (state)                 (zip)
 
Phone__________________________ Email_______________________________________________
 
Names and ages of siblings_____________________________________________________________
 
___________________________________________________________________________________
 
Father's Name_________________________________________  Cell# _________________________
 
Occupation____________________________________   Business Number______________________
 
Mother's Name_________________________________________  Cell # ________________________
 
Occupation____________________________________   Business Number______________________
 
Church Affiliation  ____________________________________________________________________
 
How did you find out about our program? _________________________________________________
 
Phone number to call in case of emergency when home cannot be reached:
 
Name____________________________________________  Phone___________________________
 
Name____________________________________________  Phone___________________________
 
(Page 1)
 
 
 
  
 
 
May teacher call doctors if necessary?  _____yes _____no
 
Physician________________________________________   Phone____________________________
 
Dentist__________________________________________   Phone____________________________
 
Remarks____________________________________________________________________________
 
___________________________________________________________________________________
 
___________________________________________________________________________________
 
I understand that the first tuition payment is due on or before July 1st. With this payment as commitment to attend the school, my child's place in the assigned class is secured.  I further understand that this payment is NON-REFUNDABLE and all decisions concerning my child's readiness should be made prior to payment.  Staff is subject to change.
NOTE: POTTY TRAINING IS NECESSARY FOR 3'S AND 4'S.
 
REGISTRATION FEE:  $85.00 (NON-REFUNDABLE AND DUE AT TIME OF REGISTRATION)
 
Payable to:  SPBC WEE CENTER
 
SIGNATURE:_________________________________________________________________________
 
 
Please circle the class of your choice:
 
TWO'S AM    3 DAYS M/W/F 9:00-11:45 $210.00
  AM 2 DAYS TU/TH 9:00-11:45 $180.00
         
THREE'S AM  3 DAYS M/W/F 9:00-11:45 $210.00
EXTENDED DAY   3 DAYS M/W/F 9:00-2:00 $270.00 
  AM
2 DAYS TU/TH 
(could be 2 1/2/3 Combo)
 9:00-11:45  $180.00
                             
FOURS AM 5 DAYS PRE-K 9:00-11:45 $295.00
  PM 3/5 DAY PRE-K 12:30-3:00 $210/$295
EXTENDED DAY   5 DAYS PRE-K 9:00-2:00  $410.00
 
  
MEDICAL FORMS RECEIVED:  _____YES  _____NO
 
DATE____________________________  INITIALS_____________
  
(Page 2)
 
     
      Additonal forms to be completed for registration.