REGISTRATION FORM FOR 2010/2011 BETHEL LUTHERAN PRESCHOOL 8712 Plantation Lane Manassas, VA 20110 Child’s Name_____________________________________ Birthdate ______________ Parent’s Names____________________________________ Phone #________________ Address__________________________________________________________________ City______________________________________________Zip Code_________________ How did you hear about our preschool? _______________________________________ __________________________________________________________________________ PLEASE CHECK THE CLASS YOU WISH TO REGISTER FOR: TUITION REGISTRATION ACTIVITY FEE (per month) FEE (one time fee) 4 YEAR OLD CLASS ____Monday/Wednesday/Friday $145 $70 $30 ____Pre-Kindergarten(M/T/W/Th/F) $190 $70 $30 3 YEAR OLD CLASS ____Tuesday/Thursday $125 $70 $30 ____Monday/Wednesday/Friday $145 $70 $30 Enrolled student must be 3 (or 4) by September 30, 2010 IMPORTANT NOTE: Your child’s original birth certificate must be shown to the director before the first day of classes and a copy of your child’s immunization record must be on file. Please obtain these forms before orientation in September. The Activity Fee is due with your child’s September tuition. This one time fee covers the cost of special activities planned throughout the year such as field trips. Your child will also receive a Bethel Lutheran Preschool t-shirt. Please note that your registration fee is NONREFUNDABLE. Please return this form and registration fee to the Preschool office as soon as possible. If you have any questions, please call Charlene Shepard at 703-368-7125 (office) or 703-369-3448 (home). You may also e-mail the preschool at blpreschool@yahoo.com for more information. Bethel Lutheran Preschool does not discriminate on the basis of race, color, religion, national or ethnic origin Website: www.bethelmanassas.org/preschool.html