Women's Bible Study
REGISTRATION
for the Fall of 2010

Please fill out the form below then
click on the Submit button at the bottom of the page to register.

Fall Study
Name
Address
City
State & Zip
Email
Home Phone
Questions/Comments

Babysitting Needs

The cost of child care is $3/week for the first child and $1/week for each additional child,
which will be collected in class each week.
1st Child
Age
Allergies
Potty trained?
Special needs/fears
Favorite color
Nap/Bottle time

2nd Child
Age
Allergies
Potty trained?
Special needs/fears
Favorite color
Nap/Bottle time

3rd Child
Age
Allergies
Potty trained?
Special needs/fears
Favorite color
Nap/Bottle time