Advent Lutheran Church
Child Development Center
2230 Rock Spring Road
Forest Hill, MD 21050

		_____________________________ Last name,     First name
Registration Date _____________		___________   _________   Class                    days
Admission Date ________________
Child's Name: _________________________________		Date of Birth: _________________
Mother's Name: _________________________________		Work phone: _________________
Father's Name: __________________________________		Work phone: ________________
Family Address: _____________________________		Home phone: ________________
__________________________________		Religious affiliation:
__________________________________		___________________________

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Registration Fee: ______________
Total Paid:       ______________		Cash ______ Check _______
		Received by: _________________
I will pay weekly _______	I will pay bi-weekly ________	I will pay monthly _________

Annual registration fee is non-refundable. First tuition payment is due on the child's first day of class.

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Please be advised:

• Two weeks written notice is required prior to withdrawing your child from the center.
• Children will not be permitted to attend class until all required forms are submitted and approved by the Child Development Center director.
• Advent Lutheran Church and Child Development Center admits children of any race, color, national and ethnic origin, accords and makes available all rights, privileges, programs and activities to all children at our center. It does not discriminate on the basis of race, color, sex, national or ethnic origin in the administration of its educational policies or any centered administered programs.

I have fully read and understood all of the above mentioned policies and agree to complete adherence.

_________________________ Parent signature

_________________________ Date

_________________________ Parent signature