CHILDREN'S PRAISE 'N RAINBOWS
Registration for 2007/2008

Child's Name:
____________________ ____________________
 
(Last Name) (First name)
   
Child's Birth Date:
_______________    
 
(month/day/year)    
   
Parents Names: _______________________________________________
  (Mother)
   
  _______________________________________________
  (Father)
 
Address: _______________________________________________
  (Street)
   
 
__________________________ _____ _____________
 
(City) (State) (Zip)
   
Phone #: (_____) _______________
   
Email: ________________________________________
         
Program Day: Mon. _____ Tues. _____ Thurs. _____ Any Day_____
  (IMPORTANT: Please give a 1st and 2nd choice)
   
We are:

A Current CPR Family
A New Family
Praise Members
 
Will you have more than 1 child attending?.............Yes / No

I am interested in being a paid substitute.................Yes / No / Maybe
(no experience necessary)


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