BETHEL NURSERY SCHOOL

90 Bryn Mawr Avenue, Auburn, MA 01501

 

ENROLLMENT APPLICATION

(A non-refundable registration fee of $25.00 applies.)

 

2 days - Tues. and Thurs. 9:00 - 11:30 A.M.                   

 

3 days Mon., Wed., and Fri. 9:00 - 11:30 A.M.                           

 

If you are interested in a Pre-K afternoon class, please speak

to the Director.

 

For School Use:

Date of Admission:                         

 

Registration Fee Paid:                    

 

Age at Admission:                          

 

Primary Language:                          

 

 

CHILD'S NAME (First)                                                        (M. Init.)                (Last)                               

 

DATE OF BIRTH                                                  PLACE OF BIRTH                                                         

 

PARENTS NAMES: (Father)                                                      (Mother)                                                                 

 

Home Address                                                                    Home Address                                                               

 

__                                                                                                                                                                                      

 

                                                                                                                                                                                           

 

Home Phone:                                                                          Home Phone:                                                                 

 

OTHERS IN FAMILY/RELATIONSHIP

 

                                                                                                                                                                          

 

                                                                                                                                                                          

 

BUSINESS ADDRESS

 

MOTHER - NAME OF BUSINESS                                                                                     TEL. NO.            

 

ADDRESS                                                                                                            HRS. AT WORK             

 

 FATHER - NAME OF BUSINESS                                                                                      TEL. NO.        

 

  ADDRESS.                                                                                                           HRS. AT WORK             

 

IF PARENTS CANNOT BE CONTACTED, NOTIFY

 

 NAME                                                                                    RELATIONSHIP                                                                

 

 ADDRESS                                                                                          TEL NO.                                                                

 

  NAME                                                                                    RELATIONSHIP                                                               

 

  ADDRESS                                                                                            TEL. NO.                                                               

 

 CHILD'S PHYSICIAN/CLINIC                                                                            TEL. NO.                                                    

 

 CHURCH/SYNAGOGUE                                                                                                     

 

IDENTIFYING INFORMATION: (Required by the Office for Children Regulation)

 

             EYE COLOR                                     HAIR COLOR                               HEIGHT                                      

 

             WEIGHT                                           SEX                RACE                      

 

             IDENTIFYING MARKS                                                                                      

 

 

 

     PARENTS SIGNATURE                                                                                                        DATE