BUSY BEE PRE-SCHOOL

69 WASHINGTON STREET
WHITMAN  MA 02382

KIDS FUN DAY   REGISTRATION FORM

 
CHILD'S  NAME__________________________________________________  AGE: _____________________________

ADDITIONAL CHILDREN'S NAMES: ____________________________________________________________________

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PARENT'S NAME:  FATHER: _____________________________ MOTHER:____________________________________

ADDRESS: ________________________________________________________________________________________

EMERGENCY PHONE NUMBER: ______________________________________________________________________
(For this day only)

EMERGENCY PHONE NO. # 2: _______________________________________________________________________
(For this day only)

PLEASE LIST ANY ALLERGIES OR SPECIAL INSTRUCTIONS THAT YOU FEEL WE SHOULD KNOW:

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Full payment must accompany all registration forms.  All deposits are non-fundable.

Signed:____________________________________________________________________

Print Name: ________________________________________________________________