Big Top Child Care Center

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Center Ring Summer Registration Form
Please print this form. Complete the information requested and mail with deposit fee to: The Big Top Child Care Center
225 Brock Bridge Road
Laurel, MD 20724-2263

Child/ren's Name(s)

Birthdate(s)

Grade Entering Sept 2010
        
        
        
Parent(s) or Guardian(s), please print names, addresses, and both business and home phone numbers of parent(s) or guardian(s):
Mother's Info: Father's Info:

Name:

Name:
Address:
 Address:
Home Phone: Home Phone:
Work Pnone: Work Phone:
Email: Email:
Camp Weeks: Initial next to each week you would like your child to attend

Summer 2011
June 20-24 ________   July 18-22 ________
June 27-July 1 ________   July 25-29 ________
July 5-8 ________   Aug 1-5 ________
July 11-15 ________   Aug 8-12 ________
      Aug 15-19 ________
Fees: $200 activity fee (due at time of registration). Breakfast, snacks, & lunch are all included!

Waiting list priorities will be established by date of receipt of this application.