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The Church Mouse

By Elaine Butler,2014-06-28 11:00
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The Church Mouse ...

     FOR The Church Mouse Nursery School

     OFFICE USE ONLY First Baptist Church Teacher________________ 202 Milton Avenue Class _______________ Ballston Spa, N.Y. 12020 Year 2009-2010

    Child’s Name_____________________________________________________________Birth Date_____/_____/________

     (First) (Last)

Name Child should be called in class___________________________________________ Sex: M____ F____

    Address____________________________________________________________________PHONE#__________________

     (Street)

_____________________________________________________/__________________________/__________________________________________

     (City) (State) (Zip Code)

    Father’s Name________________________________________________________________________________________

     (address, if different from child’s) (cell pone #)

    Mother’s Name________________________________________________________________________________________

     (address, if different from child’s) (cell phone #)

Name of Babysitter or Legal Guardian during school hours______________________________________________________

_______________________________________________________________________/_______________________________

     (address of above) (Tel. #)

Who shall be notified if parents cannot be reached? These people must be able to pick up your child if we cannot reach you:

1. _____________________________________________________________________/______________________________

     (Name) (Tel. #)

2. _____________________________________________________________________/______________________________

     (Name) (Tel. #)

It is important that we be able to reach either parent during school hours, if an accident or sudden illness should occur:

Father: _________________________________________________________________/______________________________

     (Place of Employment) (Tel. #) (Ext.)

Mother: ________________________________________________________________/______________________________

     (Place of Employment) (Tel. #) (Ext.)

Doctor’s Name __________________________________________________________/______________________________

     (Tel. #)

    YOUR CHILD MUST BE COMPLETELY* TOILET TRAINED BEFORE HE/SHE ENTERS NURSERY SCHOOL.

(*This means no consistent accidents, no pull-ups, or rubber pants in school.)

Any food allergies, medical problems, negative habits, etc. which the teacher should be aware of and could limit child’s ability

to function normally in a classroom setting? (please explain) ____________________________________________________

______________________________________________________________________________________________________

     *Classes Available: Please number your first & second choice using “1” & “2”:

     3-YEAR-OLD Morning (M/W) _____ 4-YEAR-OLD Morning (M/W/F) ______

     3-YEAR-OLD Morning T/TH) _____ 4-YEAR-OLD Afternoon (M/W/F______

     3-YEAR-OLD Afternoon (T/TH) _____ PRE-K Morning (Monday-Friday) _____

     PRE-K Afternoon (Monday-Friday) _____

*Class availability is subject to change based on enrollment. A minimum of 14 students is needed to form a class.

     Special Note: A non-refundable registration fee of $50.00 must be included with this form.

     Only one registration fee is needed for multiple enrollments per household.

     Make checks payable to:

     Church Mouse Nursery School, 202 Milton Avenue, Ballston Spa, N.Y., 12020

     phone (518)885-8362

Do you have a child currently attending Church Mouse? _________

How did you hear about the Church Mouse?

Someone attending Church Mouse______ Neighbor______ Newspaper_____ Flier_____ Other _______

Do you currently attend church?* ______ If yes, which church? __________________________________

    *This information is used by The First Baptist Church of Ballston Spa to make our families aware of opportunities to attend events and services.

    ………………………………………………………………………………………………………………………….

     For Office Use Only

    Date: ______________________ Registration fee $50.00 cash ________ Check #__________

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