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80. 00 per month Office Use Only Check Date Rec d Packet Rec d Confirmation Sent Sibling Ext. Day BETHANY LUTHERAN CHURCH 4200 N. 204th St. Elkhorn Nebraska 68022 402-289-3284 E-mail bethany. Bethany s Christian Preschool 2016-2017 Registration Form Today s Date Child s Date of Birth Male/Female circle one Child s Name Last Middle First Name to use at school Father s Name Work Phone Home Phone Cell Phone mom dad Main Contact E-mail Address City Zip Church Affiliation Names and ages of other...
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