WEST SHORE LUTHERAN SCHOOL
3225 Roosevelt Road
Muskegon, MI 49441
(231) 755-1048 Phone (231) 759-3289 Phone
Fax: (231) 755-6942
Email: [email protected]
Brad Feenstra – Principal
Tammy Ewalt – Office Administrator
Lisa Serene – Early Childhood Director
“Where Christ Lights the Way”
---------------------------------------------------------------------------The Center shall provide the following basic services for Infant/Toddler Care:
_________________
(Date of Birth)
_______________________________________________________________
(Child’s Name)
________________________
(Gender)
Parent/Guardian is: _________________________________________ _____________________________________
(Name)
(Relationship)
_________________________________________________________________________________________
_________________________________________
(Address, City, State & Zip)
_________________________________________________
(Phone)
_________________________________________________________________________________
(School District)
(Email address required for billing purposes)
Days Infant/Toddler care is needed: circle days and list hours.
Monday
Tuesday
Wednesday
Thursday
Friday
Start Date______________________
From___________
From___________
From___________
From___________
From___________
To______________
To______________
To______________
To______________
To______________
If your schedule needs to change let us know in writing so that we can make the appropriate changes to meet your new
infant/toddler care needs.
The rates below are weekly rates and are due the Friday of the previous week. Starting 7/3/17 the rates will increase.
5 Days
$180
7/3/17
$190
4 Days
$165
7/3/17
$175
3 Days
$140
7/3/17 2 Days
$150 $100
7/3/17
$100
1 Day
$60
7/3/17
$60
*Your account will be billed if your child is not in attendance on a scheduled day and no cancellation
communication was made.
* There is a $35 (school year) non-refundable registration fee required when submitting this
form.
_______________________________________________
(Signature)
______________________________
(Date)