Registration Form Registration Form Registration Form Starting Line Preschool Enrollment Application & Agreement Student (s) Information Name * First Name Last Name Age Birthday Days a week (M- T- W- Th - F) 2's Class Option 3's Class Pre/ K Class (M-T-W-Th-F) Half Day | Full Day Half Day Full Day Name * First Name Last Name Days a week (M- T- W- Th - F) 2's Class Option 3's Class Pre/ K Class (M-T-W-Th-F) Half Day | Full Day Half Day Full Day Extended Day Options Early Drop Off Late Pick Up Parent Information (Mother) * First Name Last Name Phone * (###) ### #### Email * Parent Information (Father) * First Name Last Name Phone * (###) ### #### Email * Home Address * Any Medical Conditions We Should Know About . (Food Allergies, ETC) * In case of an Emergency, other than parents whom may we contact? * Phone * (###) ### #### Enrollment Agreement Please initial each section listed below, then sign and date at the bottom. REGISTRATION FEE: I understand that an annual, non-refundable, registration fee of $75.00 shall be paid in advance to enroll my child. * PAYMENT OF TUITION: I understand that tuition is due and payable, on the first day of each month. Late fees will be applied after the 10th of each month. I understand that the school year starts in August and ends in May. Tuition is 10 monthly payments. * LATE OR UNPAID TUITION: If payment in full is not received when due, I agree to pay a late payment fee of $25.00 per month that tuition is not received. I understand that if my account is delinquent for more than one month, I may be asked to withdraw my child until my account is made current. The school cannot guarantee a child’s spot will be held when a child is withdrawn due to non-payment of tuition. Any unpaid tuition fees may be sent to a third-party collection agency. * LATE PICK-UP: I understand that if I fail to pick up my child by the scheduled pickup time, I will be charged a late fee of $1/minute after the first 5 minutes. * RETURNED CHECKS: I understand that a processing fee of $40.00 will be charged to my account for all checks which are returned for any reason. * ILLNESS: I understand that I will be notified should my child become ill during the day, and that I will pick up my child promptly, I will follow the procedures outlined in the Parent Handbook for bringing my child to school following an illness. I understand that tuition payments are not adjusted for sick/missed days. * WITHDRAWAL FROM PROGRAM: I understand that if I remove my child from the program there is a $150.00 withdrawal fee. I understand that I must provide a two (2) week written notice of withdrawal from the program. If this notification is not provided, I agree to pay all tuition and fees for two weeks, whether my child attends or not. I understand that when my child is withdrawn, he/she will only be eligible for re-admission based upon space availability. If there is an outstanding balance (including tuition or fees) when my child was withdrawn, I will be required to bring my account current prior to re-enrollment. * HOLIDAYS: I understand that the school follows Carmel Clay School System with closures for the following holidays: Labor Day, Fall Break, Thanksgiving, Winter Break, Martin Luther King, Jr. Day, President’s Day, Spring Break. I understand that tuition payments are not adjusted for holidays. * INCLEMENT WEATHER: I understand that the school follows Carmel Clay School System when it comes to closing for snow/ice. A two-hour delay or an e-learning day will result in a two-hour delay with no class for the 2 year old class. Tuition is not adjusted. * Parent Guardian * First Name Last Name Office Use: Date Received: ___________________ Registration fee Paid: ___________________ Thank you!
