BENSALEM BAPTIST SCHOOL  

RE-ENROLLMENT FORM

2009-2010

Student's Name  

Address  

Home Phone Number  

Anticipated Grade For Next Year  

Name of Church You Currently Attend  

How Often Do You Attend:  Weekly  Bi-Weekly  Monthly

Quartely  Annualy

It is my desre to re-enroll my child in the Bensalem Baptist School for the 2009-2010 school year.  

Payment by check should be delivered to the school    Pay by Check

payment by cash should be delivered to the school      Pay by Cash  

Payment by credit is only available online     Pay by Credit

(Credit card otion via paypal will be available after you submit this form)

*Parent Signature  

Date  

*Filling in this box will be recognized as an official signature.  

Registration Fee For Each Child:  (Non-Refundable)

       $50.00 by May 1

       $60.00 by May 18

       $80.00 by June 1

       $150.00 after June 1

*Enrollment date will be recognized when both form and payment are   received by the school office.