BUSY BEES EARLY LEARNING PROGRAM REGISTRATION

BUSY BEES EARLY LEARNING PROGRAM REGISTRATION Child’s Name: ______________________________________DOB___________ Home Address:____________________________________________________ Mother’s Name_____________________Father’s Name___________________ Email Address:_____________________Home Phone #:__________________ Mom’s Cell #:______________________Dad’s Cell #:_____________________ Please mark requested days per week:

Monday

Wednesday

Friday

Tuition: One day per week - $30/day Two days per week - $27.50/day Three days per week - $25/day Payment is not required for holidays that fall on the Clay County school calendar. Non-Refundable Registration & Supply Fee: $40/one day per week, $50/two days per week, and $60/three days per week. This fee is due twice- once at registration and also at the end of Christmas break. Busy Bees Coordinators: Cathy Holton: [email protected] Barbara Mercer: 904-541-1234

Videos and photos may be taken of your child and used for future promotion and marketing, such as Facebook and the Grace Anglican Church website. By registering your child, you are giving us permission to use these images in promotional materials.

Parent’s Signature:____________________________________Date:_________ (Please fill out other side for emergency information)

Grace Anglican Church ! 5804 US Highway 17 South ! Fleming Island, FL 32003 www.graceanglican.church ! (904) 541-1234

Busy Bees “Bee-Prepared for Anything” Emergency Information Child’s Name:________________________________Nickname:_____________ Siblings names/ages:_______________________________________________ ________________________________________________________________ Emergency Contacts: 1. Name:_____________________________________Phone_______________ 2. Name:_____________________________________Phone_______________ Physician’s Name:_____________________________ Phone_______________ Allergies:_________________________________________________________ ________________________________________________________________ Additional Names for Authorized Pickup: 1. ______________________________________________________________ Phone:_______________________Relation to Child:______________________ 1. ______________________________________________________________ Phone:_______________________Relation to Child:______________________ Please list some of your child’s favorite interests (toys, animals, games, songs, etc.):____________________________________________________________ ________________________________________________________________ Any particular fears?________________________________________________ ________________________________________________________________ Any additional information we should know about your child?________________ ________________________________________________________________ We look forward to having your child joining our Busy Bees Family!