ࡱ>  Root EntryZ O2FgdCONTENTS CompObjVSPELLING)Nv |`R` >   4 X 4JLN(2"'( ) @S ,12"'( ) @S 1 1 NZvrRrRr "$ 08& "$ 08" "$ 08 "$ 08" "$ 08 TSHBTSH:. "" $ "tt(ONTTimes New Roman " " "F"\""V"wy"` "`""A."@"\""V"wy"` "`".""p"p Sibling names & ages___ Z O2Quill96 Story Group Class9qCHNKWKS TEXTTEXT FDPPFDPPFDPCFDPCSTSHSTSHSTSHSTSHVSYIDSYIDtSGP SGP INK INK BTEPPLC BTECPLC FONTFONT<STRSPLC :FRAMFRAM6DOP DOP Little Lamb Learners Registration Form Please send a $50 nonrefundable registration check and this completed form to Little Lamb Learners, 135 Quarry Rd, Alburtis, PA 18011 (First tuition payment is due May 15th.) ___Twos -Thursday 9:15-11:45 $60/ month ___Threes-Tuesday/Friday 9:15-11:45 $100/month ___ AM Fours -Monday/Wednesday/Thursday 9:15-11:45 $120/month ___PM Fours-Monday/Tuesday/Thursday 12:30-3:00 $120/month ___Pre K-Monday thru Thursday 9:15-11:45 (must be 5 by 1/1) $145/month Child s Name______________________ Nickname____________ Boy/Girl________ Date of Birth____________________________ Home Address__________________________________________ Home Phone______________________Cell____________________ Sibling names & ages___________________________________________ School District___________________ Email________________________ Parent/Guardian s Information Parent/Guardian s Information Name______________________ _________________________ Occupation__________________ _________________________ Employed at_________________ _________________________ Work Phone_________________ _________________________ How did you hear about Little Lamb Learners?_______________________ Is either parent a member of Church of the Good Shepherd?_____________ I would like more information about the church services. Yes____ No_____ Is there any language other than English spoken at home?_______________ Is your child potty trained?______________ List child s allergies____________________________________________ Has your child ever received services from the IU for speech, behavior, learning support, etc? ___________________________________________ Parent Signature_________________________ Date________________ ___________________