WEE Registration Form 2009/2010

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_______________________

Address__________________________________________________________________

(street) (city) (state) (zip)

Phone__________________________ Email_____________________________________

Names and ages of siblings____________________________________________________

___________________________________________________________________________________

Father'sName______________________________________ 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________________________

(Page 1)

May teacher call doctors if necessarty? _____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 will continue holding my child's place in the assigned class.

I further understand that this payment is NON-REFUNDABLE and all decisions concerning

my child's readiness should be made prior to payment.

NOTE: POTTY TRAINING IS NECESSARY FOR 3'S AND 4'S.

REGISTRATION FEE: $75.00 (NON-REFUNDABLE)

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	$195.00
	AM	2 DAYS TU/TH	9:00-11:45	$175.00

THREE'S	AM	3 DAYS M/W/F	9:00-11:45	$195.00
	PM	2/3 COMBO	12:30-3:00	$195.00
	AM	2 DAYS TU/TH	9:00-11:45	$175.00
		(could be 2/3 combo)
FOURS	AM	5 DAYS PRE-K	9:00-11:45	$250.00
	PM	3 DAYS/5DAYS	12:30-3:00	$250.00

MEDICAL FORMS NEEDED: _____YES _____NO

FORMS RECEIVED: DATE____________________________ INITIALS_____________

(Page 2)

The WEE Center is a family ministry reaching over 100 students and their families. Our best advertisement is our families themselves. We continue to receive families who attended as a child and now are bringing their children here. People call us from all over the United States saying they have heard about our school and want to register. We have 3 classes of two year olds, four classes of three year olds, 3 classes of four year olds and a staff of nineteen dedicated teachers.

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