REGISTRATION 2017-2018

BrentwoodBaptist.com/bycs. Today's Date. Child's Name q Male q Female. Date of Birth. Street Address. City. State. Zip Code. Mother's Name. Father's Name.
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A Ministry of Brentwood Baptist Church 7777 Concord Road, Brentwood, TN 37027 Phone 615.324.6117 • Fax 615.324.6192 BrentwoodBaptist.com/bycs

REGISTRATION 2017-2018

A $75 non-refundable registration fee is required at the time of registration. Today’s Date Child’s Name q Male

q Female

Date of Birth

Street Address City State Zip Code Mother’s Name

Father’s Name

Home Phone

Home Phone

Work Phone

Work Phone

Cell Phone

Cell Phone

Email Email

Member of Brentwood Baptist Church?

q Yes q No

Regular Attender of Brentwood Baptist Church?

q Yes

q No

Other Church Affiliation Does your child have any allergies?

q Yes q No

Does your child require an EpiPen?

q Yes

q No

q Yes

q No

What language is spoken in your home? Is a parent or legal guardian serving on active duty in the armed forces of The United States?

Please check the desired programs and, if appropriate, indicate 1st choice and 2nd choice: The birthdate ranges below show which program(s) your child is eligible for. If needed, you may refer to the birthdate chart in the BYCS registration information brochure. Program

Birthdate Range

Meets On

Hours

Tuition



2-Day

04/01/14–02/29/17

Tue/Thu

9:00 AM–2:30 PM

$245



3-Day*

01/01/12–09/30/14

Tue/Wed/Thu

9:00 AM–2:30 PM

$355



4-Day*

01/01/12–08/15/13

Mon–Thu

9:00 AM–2:30 PM

$465

* Must be potty-trained and NO pull ups. Office Use Only

Date rec’d

Time

Amount

CK#

Initials Rev.12/2015