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Bethany Day Care Center Application
An enrollment of $50.00 per child (non-refundable) is charged at the time of scheduled entry.
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* Indicates required question
Child's Name
*
Your answer
Gender
*
Female
Male
Child's Birthdate
*
MM
/
DD
/
YYYY
Address
*
Your answer
School Attending
If Applicable
Your answer
Parent Information
Father's Name
Your answer
Occupation
Your answer
Business Address
Your answer
Business Phone
Your answer
Hours
Your answer
Cell Phone
Your answer
Email
Your answer
Mother's Name
Your answer
Occupation
Your answer
Business Address
Your answer
Hours
Your answer
Cell Phone
Your answer
Email
Your answer
Other Information
Name & Ages of Siblings
Your answer
Church Affiliation
Your answer
Does your child have any particular problems or fears?
*
Your answer
Does your child have any allergies?
*
Your answer
I wish to enroll in:
*
Full Days
Partial Days
Preschool
Kindergarten
Latchkey (Before and/or After School)
Virtual Learning Assistance
Other:
Required
Desired date of enrollment
*
MM
/
DD
/
YYYY
Desired days of attendance
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Hours attending
*
Center hours of operation are 6:00am-6:00pm
Your answer
How did you hear about Bethany Day Care Center?
*
Facebook
Google Search
Word of Mouth
Bethany Bible Church
Other:
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