Wilshire ECLC Registration Form 20122/23 CHURCH/PRE-COVID

Submission

MonthDayYear
Wilshire Baptist Church
Early Childhood Learning Center
4316 Abrams Rd, Dallas, TX 75214
Tel: 214-452-3115 Fax: 214-452-3162
eclc@wilshirebc.org
Wilshire Early Childhood Learning Center
Registration Form 2022-2023

CHURCH MEMBERS/PRE-COVID FAMILIES

ONE FORM PER CHILD

PLEASE SUBMIT YOUR $400, PER CHILD, REGISTRATION FEE TO THE ECLC OFFICE

USE WILSHIRE'S NORTH PARKING LOT TO ENTER.
YOUR REGISTRATION IS NOT COMPLETE UNTIL THIS PAYMENT IS RECEIVED.

REGISTRATION FEE IS NON-REFUNDABLE IF YOUR CHILD IS PLACED. PAYMENTS ARE ONLY KEPT IF YOU ARE ACCEPTED INTO THE PROGRAM.

PLEASE WRITE EACH CHILD’S FIRST & LAST NAME IN MEMO OF CHECK. IF REGISTERING MORE THAN ONE CHILD ONLY 1 CHECK IS NEEDED PER FAMILY BUT PLEASE NOTE THE FEE IS STILL $400 PER CHILD.
THIS FORM IS CURRENTLY ONLY AVAILABLE FOR VIEWING.
Child's Name*

First NameLast NamePreferred Name
Birth Date*

MonthDayYear
Gender*
Parent One Name:*
Email (parent one):*
Parent One Phone Number*

Area CodePhone Number
Parent Two Name:
Email (parent two):
Parent Two Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age Group (on or before September 1, 2022)*
Infant-Toddlers/Twos - minimum of 2 days maximum of 4 days

Threes - minimum 2 days maximum 4 days

Pre-K - minimum 3 days maximum 4 days

Bridge -must attend all 4 day

Placements will be made on a first-come, first-served basis. Priority will be given to those who choose multiple day options.

CHURCH MEMBERS/PRE-COVID FAMILIES RATES.

INFANTS AND TODDLERS

·       2-day option for infants and toddlers $352

·       3-day option for infants and toddlers $545

·       4-day option for infants and toddlers $692

TWOS

·       2-day option for twos $341

·       3-day option for twos $512

·       4-day option for twos $682

THREES

·       2-day option for threes $341

·       3-day option for threes $512

·       4-day option for threes $682

PRE-K FOURS

·       3-day option pre-k fours $511

·       4-day option pre–k fours $682

KINDER-BRIDGE

·       4-day bridge $730

Please note that if you choose "flexible" you are agreeing to any days available and if placed your non-refundable registration fee check will be cashed. You will not be notified to ask if the days available work for you. If you are not flexible you may make the same choice for each of the 3 options.
Days 1st Choice*
Days 2nd Choice*
Days 3rd Choice*
Additional Comments Regarding Choice of Days...
ARE YOU A WILSHIRE CHURCH MEMBER?*
Should be Empty: