Academy Childcare

HEY MOMS & DADS! Mail this completed Child Care RegistratioD Form, FlJLL PAYMENT. payable in U.S. funds ONLY DO later thaD 9125/95 to:

ACCENT on Arrangements, IDe, ~38 LaCayeUe Street, Suite 201, New OrleaDs, LA 70113. Phone' (504) 524-1227 FAX (504)524-1229. We must have a miDimwil of 20 children to operate the child care center. Please read carefully.

A.A.O. CHILD CARE REGISTRATION FORM Please indicate the age each child will be on October 30, 1995. (Please type or print!)

CHILD'S NAME:._ _ _ _ _ _ _ _ _ _ _AGE:_ _SEX:_ _BIRTHDATE._ _ _ _ __ CHILD'S NAME: AGE: SEX: BIRTHDATE,_ _ _ _ __ CHILD'S NAME: AGE: SEX: BIRTHDATE,_ _ _ _ __

Rates for advance registration child care are $8.00/hour with a consecutive 3-hour minim1DD; and $10.00 for children younger than 2 112 years. $6.00/hour for second and subsequent children in the family over 2 112 years, and $8.00 for children younger than 2112. Rates for ~ registration child care are $10.00 per hour with a consecutive 3-hour minim1DD; and $U.OO per hour for children younger than 2 112 years. $8.00/hour for second and subsequent children over 2 112 and $10.00 for children younger than 2 112 years. A one-time non-refundable $10.00 registration fee is required for both advance and on-site • trati on. rewsl

DATE Sun Mon The Wed Thu

Oct 29 Oct 30 Oct 31 Nov 1 Nov 2

Day

THEME FOR THE DAY - All activities are in the convention center and include arts and crafts activities focused around the theme. Welcome to Atlanta - Learn about the city's landmarks Olympic Games "Trick or Treat" - It's Halloween "Oh. the leaves are red and yellow in the fall" Entertainment under the Big Top Rate@ # of Total Center Children Total $8.00/hr Hours Drop-Orr Pick-Up Hours (advance rate)

Sun

Oct 29

Mon The Wed Thu

Oct 30 Oct 31 Nov 1 Nov 2

7:30a-7:3Op 7:30a-6:000 7:30a-6:00p 7:30a-6:000 7:30a-6:00p

Subtotal: $10.00 per child non-refundable administrative fee:

$ $ $ $ $ $

TOTAL:

$

$ $ $ $

PAYMENT (please check): Check_ Visa

Mastercard_ Card#_ _ _ _ _ _ _ _ Exp. Date: _ _

The child(ren) named above wiU be Released ONLY to the person(s) signing this appUcalion and the joUowing additional person(s).

Father/Guardian Full Name:

Signature:, _ _ _ _ _ _ _ _ _ _ __

Mother/Guardian Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ Signature: _ _ _ _ _ _ _ _ _ __ Address: _ _ _ _ _ _ _ _ _ _ _ _City:, _ _ _ _ _ _ _ _State: _ _ _ _ Zip: _ _ _ __ Room #:

Name of Local Hotel: Phone:

Daytime

Phone #:, _ _ _ _ __ Nighttime

Drivers License #:, _________

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