Bethany Day Care Pre-Registration Application
An enrollment fee of $50.00 per child (non-refundable) is charged at the time of scheduled entry.
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What is your child's name? *
What is your child's gender? *
What is your child's birthdate? *
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What school does your child attend? (if applicable)
What is the mother's name?
What is the father's name?
Home Address
Cellphone *
Email Address *
I wish to enroll my child in (check all that apply): *
Required
Desired Enrollment Start Date: *
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Desired Days of Attendance (check all that apply): *
Required
How did you hear about Bethany Day Care Center?
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