OCEAN DAY SCHOOL

REGISTRATION 2010-2011

Complete a separate registration form for each child

& return with non-refundable registration fees.

Pre-K $200.00/K-8 $500.00

PLEASE PRINT:

Student’s Last Name ____________________First Name ____________________

Date of Birth (month) _____________ (day) ___________(year) ______________

Grade to enter fall 2010 _______________

Contract Child Care times _____________

Per Diem Child Care days _____________

Contracts are to be made in the name(s) of:

Father’s Last Name _____________________First Name ____________________

Mother’s Last Name ____________________First Name ____________________

Student’s Home Address

Street ___________________________  City _________________Zip Code _____

Home Telephone __________________________________________

Father’s Employer _______________________________________

Occupation            _______________________________________

Father’s Work Phone _____________________________________

Mother’s Employer ______________________________________

Occupation             _______________________________________

Mother’s Work Phone _____________________________________

Office use only:

Received ______________

Reg. fee check # ________