REGISTRATION FORM Name: ___________________________________________ DOB:_____/______/_____ Address:________________________________________________________________________________ Name of Parent(s)/Guardian(s):__________________________________________________________ Home Tel. #:___________________ Work Tel. # ____________________ E-Mail:_____________________ Person to contact in case of emergency (Name, Tel. #, Relationship) _____________________________________________________________________________________ WINTER/SPRING 2010 Class(es) you are registering for : VILLAGE - COCK-A-DOODLE-M00 __________ OUR TIME - AWAY WE GO! _____________ IMAGINE THAT! - TOYS I MAKE__________ YOUNG CHILD 4 _______________ ********************************************************************************************** |
