Session Dates are March 5 thru April 4, 2012 on Mondays and Wednesdays
Place: At Bellmont High School NO CLASSES DURING THE WEEK OF SPRING BREAK
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: Feb. 28, 2012
Registration for NON Adams County Residents
Begins: March 1, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
5:00 - 5:40 p.m. 5:45 - 6:25 p.m. 6:30 - 7:10 p.m.
___Preschool 1 (must be 3) ___Parent n Tot ___Preschool 2 (ages 4 & 5)
___Preschool 2 (ages 4 & 5) ___Preschool 1 (must be 3) ___Preschool 1 (must be 3)
___Level 2 (age 6 & up) ___Level 3 ___Level 2 (age 6 & up)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
5:00 - 5:40 p.m. 5:45 - 6:25 p.m. 6:30 - 7:10 p.m.
___Preschool 1 (must be 3) ___Parent n Tot ___Preschool 2 (ages 4 & 5)
___Preschool 2 (ages 4 & 5) ___Preschool 1 (must be 3) ___Preschool 1 (must be 3)
___Level 2 (age 6 & up) ___Level 3 ___Level 2 (age 6 & up)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
5:00 - 5:40 p.m. 5:45 - 6:25 p.m. 6:30 - 7:10 p.m.
___Preschool 1 (must be 3) ___Parent n Tot ___Preschool 2 (ages 4 & 5)
___Preschool 2 (ages 4 & 5) ___Preschool 1 (must be 3) ___Preschool 1 (must be 3)
___Level 2 (age 6 & up) ___Level 3 ___Level 2 (age 6 & up)
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Session Dates are April 9 thru May 2, 2012 on Monday and Wednesday
Place: At Bellmont High School
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: April 3, 2012
Registration for NON Adams County Residents
Begins: April 5, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
5:00 - 5:40 p.m. 5:45 - 6:25 p.m. 6:30 - 7:10 p.m.
___Preschool 1 (must be 3) ___Presschool 2 (ages 4 & 5) ___Parent n Tot
___Preschool 2 (ages 4 & 5) ___Preschool 3 (must pass PS2) ___Preschool 1 (must be 3)
___Preschool 3 (must pass PS2) ___Level 2 (age 6 & up) ___Level 4
___Level 3 ___Level 5
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
5:00 - 5:40 p.m. 5:45 - 6:25 p.m. 6:30 - 7:10 p.m.
___Preschool 1 (must be 3) ___Presschool 2 (ages 4 & 5) ___Parent n Tot
___Preschool 2 (ages 4 & 5) ___Preschool 3 (must pass PS2) ___Preschool 1 (must be 3)
___Preschool 3 (must pass PS2) ___Level 2 (age 6 & up) ___Level 4
___Level 3 ___Level 5
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
5:00 - 5:40 p.m. 5:45 - 6:25 p.m. 6:30 - 7:10 p.m.
___Preschool 1 (must be 3) ___Presschool 2 (ages 4 & 5) ___Parent n Tot
___Preschool 2 (ages 4 & 5) ___Preschool 3 (must pass PS2) ___Preschool 1 (must be 3)
___Preschool 3 (must pass PS2) ___Level 2 (age 6 & up) ___Level 4
___Level 3 ___Level 5
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Session Dates are June 11 thru July 4, 2012 on Monday and Wednesday
Place: At the City Pool, 315 Maple St., Decatur, In. Wed. July 4 will be made up on Fri. July 6
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: May 29,2012
Registration for NON Adams County Residents
Begins: May 31, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m.
___Preschool 1 (must be 3)
___Preschool 2 (ages 4 & 5)
___Preschool 3 (pass PS 2)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m.
___Preschool 1 (must be 3)
___Preschool 2 (ages 4 & 5)
___Preschool 3 (pass PS 2)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m.
___Preschool 1 (must be 3)
___Preschool 2 (ages 4 & 5)
___Preschool 3 (pass PS 2)
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Session Dates are June 12 thru July 5, 2012 on Tuesday and Thursday
Place: At the City Pool, 315 Maple St., Decatur, In.
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: May 29,2012
Registration for NON Adams County Residents
Begins: May 31, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m. 5:30 – 6:10 p.m. 6:15– 6:55 p.m
___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2) ___Preschool 1 (must be 3)
___Level 2 (age 6 & up) ___Level 2 (age 6 & up) ___Preschool 2 (ages 4 & 5)
___Level 4 ___Level 4 ___Level 3
___Level 5
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m. 5:30 – 6:10 p.m. 6:15– 6:55 p.m.
___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2) ___Preschool 1 (must be 3)
___Level 2 (age 6 & up) ___Level 2 (age 6 & up) ___Preschool 2 (ages 4 & 5)
___Level 4 ___Level 4 ___Level 3
___Level 5
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m. 5:30 – 6:10 p.m. 6:15– 6:55 p.m.
___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2) ___Preschool 1 (must be 3)
___Level 2 (age 6 & up) ___Level 2 (age 6 & up) ___Preschool 2 (ages 4 & 5)
___Level 4 ___Level 4 ___Level 3
___Level 5
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Session Dates are July 9 thru August 1, 2012 on Monday and Wednesday
Place: At the City Pool, 315 Maple St., Decatur, In.
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: July 3,2012
Registration for NON Adams County Residents
Begins: July 5, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m. 5:30 – 6:10 p.m. 6:15– 6:55 p.m
___Preschool 1 (must be 3) ___Preschool 1 (must be 3) ___Parent n Tot
___Preschool 3 (pass PS 2) ___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2)
___Level 3 ___Level 2 (age 6 & up) ___Level 3
___Level 4
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m. 5:30 – 6:10 p.m. 6:15– 6:55 p.m.
___Preschool 1 (must be 3) ___Preschool 1 (must be 3) ___Parent n Tot
___Preschool 3 (pass PS 2) ___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2)
___Level 3 ___Level 2 (age 6 & up) ___Level 3
___Level 4
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:15 - 12:55 p.m. 5:30 – 6:10 p.m. 6:15– 6:55 p.m.
___Preschool 1 (must be 3) ___Preschool 1 (must be 3) ___Parent n Tot
___Preschool 3 (pass PS 2) ___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2)
___Level 3 ___Level 2 (age 6 & up) ___Level 3
___Level 4
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Session Dates are Sept. 11 thru Oct. 18 on Tuesday and Thursdays
Place: At Adams Central High School, Monroe In.
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: Aug. 14, 2012
Registration for NON Adams County Residents
Begins Aug. 16, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
9:15 - 9:45 a.m. 9:45 - 10:15 a.m.
___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
9:15 - 9:45 a.m. 9:45 - 10:15 a.m.
___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
9:15 - 9:45 a.m. 9:45 - 10:15 a.m.
___Preschool 2 (ages 4 & 5) ___Preschool 3 (pass PS 2)
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Session Dates are Sept. 10 thru Oct. 3 on Fridays
Place: At Bellmont High School, Decatur, In.
To register please bring this form and payment to the Riverside Center, 231 E. Monroe St..
1st come 1st serve. Class sizes are limited
Registration for Adams County Residents
Begins: Aug. 14, 2012
Registration for NON Adams County Residents
Begins Aug. 16, 2012
For the (Preschool 1 class) the child must be 3 years old by the 1st day of class.
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:30 - 1:00 p.m. 1:00 - 1:30 p.m.
___Preschool 2 (ages 4 & 5) ___Preschool 1 (must be 3)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:30 - 1:00 p.m. 1:00 - 1:30 p.m.
___Preschool 2 (ages 4 & 5) ___Preschool 1 (must be 3)
Gender Child's Name Date of Birth Age Fee
M/F ____________________________ ___________ ___ __________
12:30 - 1:00 p.m. 1:00 - 1:30 p.m.
___Preschool 2 (ages 4 & 5) ___Preschool 1 (must be 3)
Fees: $25.00 Residents of Decatur/Adams County
$35.00 NON Decatur/Adams County Residents (outside of Adams County)
Adams Co. Res. _____ NON Adams Co. Res._____
Female of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________
Male of Household Name:___________________________________________________
Address: _________________________________________________
City: _______________ State: _____________ Zip: _______________
Home Phone: _______________ Cell: _____________ Work: _____________