Pre- Registration Form

3707 Plantation Grove Blvd.

Mission, Texas 78572

(956) 580-7444

To reserve space at our center, please complete the following information for your children. If additional space is needed, please copy this page and attach them.

Child:

Name: DOB: ___/___/___ Age: _____Sex:

Hours of Care: Full Time: Part Time:

Desired start date:

Special Concerns:

Child:

Name: DOB: ___/___/___ Age: _____Sex:

Hours of Care: Full Time: Part Time:

Desired start date:

Special Concerns:

Parent/ Guardians Information:

Parent/Guardians Name:

Address:

Home Phone: Cell Phone: Work Phone:

E-Mail Address:

A non- refundable pre- registration fee of $25.00 is due at the time you submit this form. Once payment is received, your child’s space will be reserved. A non- refundable final registration fee of $75.00 will be due July 1, 2006. Failure to pay the final registration fee by this date may result in losing your child’s space. This registration fee will not be returned in the event that the above-named child/children do not attend the center.

Paymentcan be made in the order of cash or check payable to Early Beginnings Child Care and Development Center, LLC.

Mail payments to the followingaddress:

Registration Application

3707 Plantation Grove Blvd. Ste. 1; Mission, Texas 78572

By signing below, you agree that the information you provided is correct.

Parent/ Guardian Signature: Date:

Office Use Only:

Date received: Registration Paid: Initial: