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120 Werthan Circle • Franklin, TN 37064 • 615-791-9003 • E-mail • Jobs • Home Page

PB&J Day School will accept any child without regard to race, sex, religious affiliation or national origin. © 2009-2010 PB&J Day School, LLC.

PB&J Day Summer Camp Registration Form

 

CAMP PRICING

2 days = $72/week
3 days = $108/week
5 days = $180/week

There is a $100 registration fee that applies towards your first tuition payment.

All supplies are included.

•••••••••

Click here for descriptions of all PB&J Summer Camps.

 

 

 

 

 

 

 

CAMP PRICING

2 days = $72/week
3 days = $108/week
5 days = $180/week

There is a $100 registration fee that applies towards your first tuition payment.

All supplies are included.

•••••••••

Click here for descriptions of all PB&J Summer Camps.

 

 

 

 

 

 

 

CAMP PRICING

2 days = $72/week
3 days = $108/week
5 days = $180/week

There is a $100 registration fee that applies towards your first tuition payment.

All supplies are included.

•••••••••

Click here for descriptions of all PB&J Summer Camps.

 

 

 

 

 

 

CAMP PRICING

2 days = $72/week
3 days = $108/week
5 days = $180/week

There is a $100 registration fee that applies towards your first tuition payment.

All supplies are included.

•••••••••

Click here for descriptions of all PB&J Summer Camps.

 

 

 

 

 

 

 

CAMP PRICING

2 days = $72/week
3 days = $108/week
5 days = $180/week

There is a $100 registration fee that applies towards your first tuition payment.

All supplies are included.

•••••••••

Click here for descriptions of all PB&J Summer Camps.

CHILD'S INFORMATION
Today's date:
Legal name: (first, middle, last)
Preferred first name:
Gender:	Male  Female
Date of birth (month, day, year):
Child's Soc. Sec. Number:
PARENTS' INFORMATION
Father's name:
Address:
City:
State:
ZIP:
Home phone:
E-mail:
Occupation:
Employer:
Business address:
Business phone:
Business e-mail:
	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mother's name:
Address:
City:
State:
ZIP:
Home phone:
E-mail:
Occupation:
Employer:
Business address:
Business phone:
Business e-mail:
CAMP CHOICES	(check either 2, 3 or 5 days next to the camp name)
No. of days	Camp Name
2 days  3 days  5 days	June 7-12 | Tents and S’mores and Campfires: Oh My!
2 days  3 days  5 days	June 14-18 | One Fish, Two Fish, Red Fish, Blue Fish
2 days  3 days  5 days	June 21-25 | Around the World
2 days  3 days  5 days	June 28-July 2 | Once Upon a Time
2 days  3 days  5 days	July 5-9 | Hard Hat Area!
2 days  3 days  5 days	July 12-16 | Water Works
2 days  3 days  5 days	July 19-23 | Weird Science
2 days  3 days  5 days	July 26-30 | A Day in the Knight
FAMILY INFORMATION
Child's siblings:	Name:  Age:
	Name:  Age:
	Name:  Age:
With whom does the child reside?
Legal guardian’s name   and address, if applicable
Language spoken   in the home:	English Other (please specify below)
PARENT STATEMENTS
	Please help us know your child by providing the following information. It is understood that young children continue to grow and develop; your responses should describe current circumstances.
	Personal Development:
Yes  No	Has your child attended preschool/childcare before?
If yes, school name:
Yes  No	Can your child feed her/himself using a spoon and/or fork?
Yes  No	Wash and dry her/his own hands?
Yes  No	Dress her/ himself with little assistance?
Yes  No	Speak so that he/she can be understood by others?
Yes  No	Express her/his thoughts and needs easily?
Yes  No	Is your child toilet-trained during the day?
	Health History:
Yes  No	Has your child ever had trouble seeing?
Yes  No	Has your child had frequent ear infections?
Yes  No	Does your child have allergies?
Yes  No	Has your child had any significant injuries or hospitalizations?
Yes  No	Is your child presently on any medications?
	If you responded "yes" to any of the above, please explain. Also, describe any other health concerns.
	Interests/Activities:
Yes  No	Does your child play with blocks and construction toys without help?
Yes  No	Use crayons or markers to draw?
Yes  No	Listen to stories being read out loud?
Yes  No	Turn pages of a book and look at pictures?
Yes  No	Recall stories and events?
Yes  No	Enjoy playing alone or with imaginary friends?
Yes  No	Follow simple, age-appropriate directions?
Yes  No	Talk with your friends and relatives who come to visit?
	Please describe your child's favorite activities when playing with other children:
	Please describe your child's favorite activities when playing alone:
	Please describe your child's favorite activities when at home with Mom or Dad:
	Please share anything else we should know:
DECLARATION
	By checking the box below, I am stating that the information provided here is truthful and accurate to the best of my knowledge. It is further understood that any misstatement or omission may result in denial of admission or enrollment.  I agree. (To complete your application, click on the button below.)