Grace Baptist Church
Sunday, May 19, 2013

Mother's Day Out

  What is Mother's Day Out?
 
Children two (2) years old through pre-K will participate in planned activities,
such as crafts, stories, and games, in a loving Christian environment.
 
Questions? Call the church office at 589-0424.
 

September thru May
Tuesday, Wednesday & Thursday

9:30 am to 1:30 pm
 2013-2014 Rates
Registration:
One day a week:
Two days a week:
Three days a week:
$  25 per year
$  90 per month
$170 per month
$230 per month
 
Open registration for the upcoming year begins June 1, 2013.
 
REGISTRATION FORM
 
Child's Name:   Last       First  
Child's Birth Date:     Child's Age: 
Mother's Name:     Father's Name: 
Address:    
City:     Zip: 
Email:    
Home Phone:     Emergency Contact No.: 
 
Check which days your child will attend:       Tuesday      Wednesday    Thursday
What date will they start attending?    
 
Is your child potty trained?    Yes    No
 
Allergies or Other Special Information:
 
 
 Were you referred by someone?   Yes     No    
     If yes, please provide their name:    
 
Do you have a church home?     Yes     No    
     If yes, which church? 
 
Do we have permission to use photographs of your child for promotional purposes?   Yes     No
 
Other than yourself, who is authorized to pick up your child?    
    Name:      Phone No.      Relationship:     
  
    Name:      Phone No.      Relationship:     
  
    Name:      Phone No.      Relationship:     
  
I give my permission for Grace Baptist Church to secure medical services for my child should it become necessary.
     Yes     No
 
Parent's Name:         Date:    
 
Thank you for registering your child!  
We will contact you to confirm that there's still space in the class you've selected. 
 
To finanlize your registration, the $25 registration fee needs to be paid 
by mail or in person at:  Grace Baptist Church, 2550 Jewetta Avenue.