Registration Form

Please print out, complete, and return to:

The Rising Sun Children’s Center

5224 Rising Sun Ave.

Philadelphia , PA 19120

Date:

Child’s Full Name

Date of Birth:

Home Address:

Home Phone:

Date of Desired Entry:

Schedule of Attendance Desired:

Mother’s Name:

Address:

Work Phone:

Father’s Name:

Address:

Work Phone:

Parent or Guradian Signature: