application form
To register your child for the Fall 2007 session, please complete and submit the form below. There is a $10 nonrefundable application fee required. Please mail your $10 check to:

Pennside Presbyterian Church
253 North 25th Street
Reading, PA 19606

After your check is received and application processed, you will receive verification of your child's enrollment for the next session. If you have more than one child, please complete a separate application form for each.


Child's Name

Address

City

State

Zip

Phone Number (xxx-xxx-xxxx)

Date of Birth (MM/DD/YYYY)

Parent or Legal Guardian's Name

Emergency Contact Phone Number (xxx-xxx-xxxx)

I'd like to register my child for:
Five-day classes for 4-year olds
Three-day classes for 4-year olds
Three-day classes for 3-year olds
Two-day classes for 3-year olds
Stay and Play

 

 

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