REGISTRATION FORM


YOUR NAME    : __________________________________________________________

DAYCARE NAME : __________________________________________________________

ADDRESS      : __________________________________________________________

CITY         : _____________________________  STATE : ____  ZIP : _______

PHONE NUMBER : (____)-____-__________



DISK FORMAT  : 3.5" DISKETTE ___   5.25" FLOPPY ____

WHERE DID YOU GET THE DEMO FROM : ________________________________________

COMMENTS : _______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


REGISTERED VERSION OF CHILD (V4.5)  $30.00ea            $30.00   $________

SHIPPING & HANDLING FOR EACH ORDER  $ 5.00               $5.00   $________    

MICHIGAN STATE SALES TAX 6% (MICHIGAN ORDERS ONLY)       $1.80   $________    

TOTAL ENCLOSED (CHECK OR MONEY ORDER)                            $________



MAIL THIS FORM WITH PAYMENT TO THE ADDRESS BELOW:

BRIAN DEJONG
244 NORTH 160th AVE
HOLLAND, MII
49424

(616)-396-9991



THANK YOU FOR YOUR ORDER...