BUSY BEE PRE-SCHOOL

69 WASHINGTON STREET
WHITMAN  MA 02382  
(781) 447-0600

INFANT & TODDLER PROGRAM
REGISTRATION FORM

 
STUDENTS NAME__________________________________________________D.O.B.____________________________

 ADDRESS ______________________________________________ CITY___________________ ZIP________________

  HOME  PHONE NUMBER _______________________________WORK NUMBER________________________________

 MOTHER'S NAME_______ ___________________________ FATHER_________________________________________

How did you hear about our program?    ______  Friend
                                                                 ______  Mailing
                                                                 ______  Newspaper
                                                                 ______  Other

Registration Fee:   $50.00

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