Registration Fee (Non-Refundable) - $50.00 due upon registration

Books and Supplies (Non-Refundable) - $125 due on or by Aug. 1st.

Child's Name _________                                             _male(_ )_female (  )__Date of Birth ____/____/______

Father's Name _______________________________________________     Work Number ______________

Mother's Name _______________________________________________    Work Number ______________

Home Address _____________________________________________________________

City ______________________________________ ST _______ ZIP __________________

Home Phone ____________________ Email Address ____________________________________________

Physicians to be contacted in case of an emergency.

Name ______________________________________________________   Number ____________________

My signature on the application for my child to attend "Busy Little Beavers" Christian Preschool acknowledge that I agree to all the rules and regulations set before me. It is also my desire for him/her to complete the school year and that my child participate in the entire school program unless physically hindered or an unexpected move. I also give permission for my child to take part in all school activities - including field trips away from the school premises and absolve the school and teachers from liability to me or my child because of any injury to my child at the school activity or on school grounds. I acknowledge that any medical treatment my child my need will be cover by our own family health insurance and exempts the school from any medical payments or liabilities. It is also my understanding that the school staff is hereby given full discretion regarding the discipline of my child. I have read the school rule and regulations and agree to cooperate fully with the staff of "Busy Little Beavers" Christian Preschool. I agree to abide by the guidelines set forth.

Parent's Signature - Father _________________________________________________ Date _____________

      Mother ________________________________________________ Date _____________

Please mail payments to: BLB Christian Preschool, 116 East Barnard Street, Glennville, GA 30427