Waiting List Childs Name: ______________________________ DOB: __/__/____ Age: ___yr. ___ mo. Sex: M/F Childs Name: ______________________________ DOB: __/__/____ Age: ___yr. ___ mo. Sex: M/F Childs Name: ______________________________ DOB: __/__/____ Age: ___yr. ___ mo. Sex: M/F Childs Name: ______________________________ DOB: __/__/____ Age: ___yr. ___ mo. Sex: M/F Mother’s Name: ___________________________ Father’s Name: __________________________ Mother’s Home Phone: ____________________ Father’s Home Phone: ___________________ Mother’s Cell Phone: ______________________ Father’s Cell Phone: _____________________ Mother’s Work Phone: _____________________ Father’s Work Phone: ___________________ Mother’s Email Address: ____________________ Father’s:_______________________________ ____ Infants ($190 weekly) ____Toddlers ($180 weekly) ____Two’s ($180 weekly) ____Pre-K 3 ($170 weekly) ____Mother’s Day Out ($130 weekly) ____ Before Care ($160 monthly) ____After Care ($160 monthly) ____ Before and After Care ($350 Monthly) _____ Summer Camp 2019 ($140 weekly) Bright Beginnings Owner/Director: Stacey Betz | 20000 Old Scenic Hwy Zachary, LA 70791 | Phone: 225.570.8062 | Email: [email protected] Webpage: www.brightbeginningscdc.com