BUSY BEE PRE-SCHOOL

69 WASHINGTON STREET
WHITMAN  MA 02382

DAY CARE   REGISTRATION FORM

 
STUDENTS NAME__________________________________________________D.O.B.____________________________

 ADDRESS ______________________________________________ CITY___________________ ZIP________________

  HOME  PHONE NUMBER _______________________________WORK NUMBER________________________________

 MOTHER'S NAME_______ ___________________________ FATHER_________________________________________

DAY CARE  ATTENDED PREVIOUSLY __________________________________________________________________ 

 How did you hear about us?  ________________________ ___________________________________________________ 

Please Complete the following table with the day care schedule that you will require:

STARTING DATE :   _____ / _____ / ______       Please circle one:    1) Year Round Day Care          2) School Year Only

Registration Fee:   $50.00

___________________________________________________________   Date ___ / ___ / ___
Signed by parent or guardian