Bensalem Baptist School

Re-Enrollment Form

Student Name *
Address *
Address Continued *
Home Phone Number *
Anticipated Grade For Next Year *
Church You Currently Attend
How Often Do You Attend
Pay By Cash	Cash is to be delivered to the school office
Pay By Check	Check is to be delivered to the school office
Pay By Credit (PayPal)	Payment by credit will be available after form is submitted
Registration fee for each child: (non-refundable) $ 0.00 by April 22 $ 80.00 by May 1 $ 100.00 by June 1 $150.00 after June 1
Parent Signature *
Date *