Academy of Learners ADMISSION INFORMATION Contract For Care January to December 2017

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Academy of Learners ADMISSION INFORMATION Contract For Care January to December 2017"

Transcription

1 Contract For Care Aug 2010 / Pg 1 of 7 Full of Admission of Birth This child care agreement is between (facility) and the parents of the child(ren) enrolled. Care will be provided by the director Leslie Kniskern and the co-director Sandra Mettler. Cancellation of Contract: This contract is valid from the date of enrollment until parents or caregiver provide written notice of withdrawal. Two (2) weeks notice must be provided by either caregiver or parent unless extreme circumstances are present (ie: child causing harm to other children or facility, death in family, etc). Terms of Contract Days and Hours of Care: Care will be provided on the days requested and for the hours of care specified. Early starts/late pick ups: (anytime before/after your regularly scheduled pick up time) will be charged a fee of $5.00 for every ½ hour you are early or late. This fee is automatically charged to your account and can be paid with Friday s tuition payment. Cash payment is also accepted. Tuition Payments: All tuition payments are due on Friday for the following weeks care. Tuition not paid by midnight on Friday will incur a $7.00 late fee. This fee will be applied daily at midnight until tuition is paid. Care will NOT be provided until tuition is paid. Child Tardies/Absences: Please notify us as soon as possible if your child is going to be late or absent so that we can adjust our meal prep and lesson prep accordingly. Tuition is charged regardless of your child s attendance. Meals and Snacks: All meals and snacks are included in your tuition. You are welcome to bring or provide meals if your child is on a specific diet. Formula is provided by parents. Holidays/Vacation/Closures: All holidays, training, and vacation days are listed on the parent portal. You are responsible for having backup care for your child. We reserve the right to use an additional 3 days a year (paid) for required training. All closure dates are listed at least 30 days in advance to provide adequate time for you to find backup care. From August to July the Academy takes 9 scheduled holidays (tuition paid) and 2 weeks of vacation (no tuition paid). Special Circumstances Tuition paid by more than one responsible party: If tuition will be split between responsible parties please be aware that ANY failure to pay tuition will cause the Academy to remove the child from enrollment. Divorced Parents: All pages will need to be filled out by the parent enrolling the child for care. If tuition will be split or days will differ between divorced or separated parents each parent will need to fill out a separate admission packet. A copy of your custody agreement must be on file in order to be enforced by local law enforcement and the Academy. Foster Parents: Page 7 will be placed in your family folder. Pages 1 to 6 will need to be filled out for each individual child that is placed with us. By signing this contract, I agree to abide by the terms listed above. I acknowledge receipt of the facility s ONLINE operational policies including those for discipline and guidance. I understand that a printed copy can be requested.

2 Full Aug 2010 / Pg 2 of 7 of Birth Current Age of Admission of Withdrawal Home Street Address Home City State Zipcode Home Hours in Care My child is normally in care on the following days and times: From To Monday Tuesday Wednesday Thursday Friday Tuition Rates Tuition below is for care provided for your scheduled hours. Full Time (Scheduled) Tuition is paid each week regardless of attendance, holidays, etc. $ per week $ per week Part Time (sibling) (Scheduled) Tuition is paid each week based on your reserved days regardless of attendance, holidays, etc. $36.00 per day $32.40 per day (sibling) Daily / Drop In (Varies) Tuition is paid based on your reserved days. Schedule varies and must be reserved by the parent. $36.00 per day $32.40 per day (sibling) Hourly Care Hours Hourly care is only available on school days between 8am and 3pm. $7.00 per hour Extended Care Hours When available Extended Care is provided before/after your scheduled care hours. $5.00 per half hour Drop In/Daily/Hourly or Extended Care RESERVATIONS No charge for reservations cancelled 48 hours prior to attendance. 50% cancellation fee charged for hour notice 100% cancellation fee charged for less than 24 hour notice.

3 Aug 2010 / Pg 3 of 7 Full of Admission of Birth Permission Forms By checking below I hereby GIVE my consent below for (check all that apply): Permission to transport children: for emergency care on field trips to and from school to and from home Permission for walking field trips to: the neighborhood local park Permission to participate in water activities: sprinkler play water table play splashing/wading pools Permission to take photos that will be: No identifying information will ever be posted in a public forum. posted on family album (private) used for crafts, games, education, etc. used in advertising (additional permission required) Meals Served I understand that the following meals will be served to my child while in care: Ages 1 to School Age Breakfast (8am) AM Snack (10am) Lunch (12pm) PM Snack (3:30pm) Supper (care scheduled past 6:00pm) Infants Breastmilk (provided by parent) Formula (provided by parent) Baby food (provided by The Academy) Immunization Record I have provided the childcare operation with a copy of my child s most current immunization record. IMPORTANT: Please attach a copy of your child s immunization AND any notes from your doctor regarding food allergies Child daycare operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA Information Line at (800) (voice) or (800) (TTY).

4 Full of Admission of Birth Aug 2010 / Pg 4 of 7 Medical Information List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregiver s should be aware of: School Age Children My child attends the following school: of School Address School Ph.# City State Zip CHECK ALL THAT APPLY: His / her immunization record is on file at the school and all required immunizations and/or tuberculosis test are current. Vision and Hearing screening records are also on file. of sibling(s): My child has permission to: walk to or from school or home, ride a bus, and/or be released to the care of his/her sibling(s) under 18 years old. Hearing and Vision Screening IMPORTANT: Must be completed at age 4 VISION R 20/ L 20/ PASS FAIL SIGNATURE DATE HEARING 1000 Hz 2000 Hz 4000 Hz R PASS FAIL L SIGNATURE DATE

5 Full of Admission of Birth Aug 2010 / Pg 5 of 7 Authorization for Emergency Medical Attention In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to: Physician Emergency Care Facility Hospital I give consent for the facility to secure any and all necessary emergency medical care for my child. Signature - Parent or Legal Guardian

6 Aug 2010 / Pg 6 of 7 Full of Admission of Birth Health and Medical Information ADMISSION REQUIREMENT: If your child does not attend school away from, one of the following must be presented when your child is admitted to the child-care operation or within one week of admission. 1. HEALTH-CARE PROFESSIONAL S STATEMENT: I have examined the above named child within the past year and find that he / she is able to take part in the day care program. Health Care Professional's Signature 2. A signed and dated copy of a health care professional s statement is attached. 3. Medical diagnosis and treatment conflict with the tenets and practices of a recognized religious organization, which I adhere to or am a member of; I have attached a signed and dated affidavit stating this. 4. My child has been examined within the past year by a health care professional and is able to participate in the day care program. Within 12 months of admission, I will obtain a health care professional s signed statement and will submit it to the child-care operation. Health care professional s statement must be submitted by. Health Care Professional that has seen your child in the past 12 months? Signature - Parent or Legal Guardian

7 Aug 2010 / Pg 7 of 7 Full of Admission of Birth Mother s/guardian Information Full Father s/guardian Information Full Home Address, City, State Zipcode Home Address, City, State Zipcode Address Address List telephone numbers below where parents/guardian may be reached while child will be in care Home Cellular No. Home Cellular No. Employer Information Employer Work No. Employer Work No. Work Address, City, State Zipcode Work Address, City, State Zipcode Emergency Contact Information Give the name, address and phone number of person to call in case of an emergency if parents / guardian cannot be reached. Use the back of the page to list additional people. RELEASE OF CHILDREN I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons. Please list name & telephone number for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID. Use the back of the page to list additional people. Full /Telephone #/Relationship Full /Telephone #/Relationship

Sanford-Springvale YMCA Kids Out Enrichment Program 2016/17 Registration Form

Sanford-Springvale YMCA Kids Out Enrichment Program 2016/17 Registration Form 2016/17 Registration Form SAD57 Program Information (Non-refundable registration fee of $25 for NEW participants required at time of registration): Before Care Program Sites (Please circle one) Alfred

More information

Enrollment Form 2014-2015

Enrollment Form 2014-2015 Please print clearly in blue or black ink. Enrollment Form 2014-2015 Child s Full Name: Birth Date: Address: Home Phone: ( ) City: State: Zip Code: Nickname: Pick-up Password: Enrollment options: Wednesday

More information

EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM

EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM 55 PA CODE CHAPTERS 3270 123 & 181 (C): 3280 123 & 181 (C): 3290 123 & 181 (C) CHILD S FIRST NAME MIDDLE NAME LAST NAME BIRTH DATE START DATE WITHDRAWAL

More information

Kiddie Tech University Learning Center

Kiddie Tech University Learning Center APPLICATION FOR ADMISSION Kiddie Tech University Learning Center Child s Name: Known As: Sex: Age: Yrs: Mos Date of Birth: Home Address: Home Phone: Name of Mother: Name of Father: Mother s Employer: Father

More information

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical

More information

Classes begin Monday, August 29 th, 2016 3-year-old class

Classes begin Monday, August 29 th, 2016 3-year-old class Please return completed packets to the church office, along with a $25 registration fee. Checks can be made payable to First Christian Church, with Bright Beginnings in the memo. Classes begin Monday,

More information

Johns Creek Montessori School Of Georgia

Johns Creek Montessori School Of Georgia ENROLLMENT FORM Pre-Primary (Toddler) Primary Half Day Full Day All Day Start : Child s Information: Child s Name Street Address Nickname of Birth Subdivision Name Primary Language Spoken Parent/Guardian

More information

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments.

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments. Brick Township Public Schools Brick Extended School Time Before and After School Care & Kindergarten Wrap Around 224 Chambers Bridge Rd - Brick, NJ 08723-732-262-2590 ext. 1531 BEST Program Families: Thank

More information

THE FAMILY OF FAITH PRESCHOOL REGISTRATION FORM

THE FAMILY OF FAITH PRESCHOOL REGISTRATION FORM THE FAMILY OF FAITH PRESCHOOL REGISTRATION FORM 2014-2015 The Family of Faith, 16710 FM 529, Houston, TX 77095, Phone 281-855-2950 Fax 281-855-8301 E-mail: preschool@thefamilyoffaith.org Web Site: www.tfof.org

More information

Learning Pathways Preschool Enrollment Application

Learning Pathways Preschool Enrollment Application Learning Pathways Preschool Enrollment Application Please check the location that you wish to enroll your child 4115 Jacksol Drive, San Jose 831 Malone Road, San Jose Program Enrollment (Please check one):

More information

CERTIFIED FAMILY CHILD CARE CONTRACT

CERTIFIED FAMILY CHILD CARE CONTRACT CERTIFIED FAMILY CHILD CARE CONTRACT Welcome! I am glad you have decided to enroll your child in my Certified Family Child Care. Should you have any concerns or wish to check the status of my Certification,

More information

ENROLLMENT REGISTRATION INFORMATION

ENROLLMENT REGISTRATION INFORMATION Pages 1 and 2 must be updated every January and July. Picture Parent Updates (Signature) (Date) Parent Updates (Signature) (Date) Parent Updates (Signature) (Date) School Code: Date of Registration: Date

More information

Helen Troum Nursery and Kindergarten at Temple Beth Sholom 40-25 Fair Lawn Ave, Fair Lawn, NJ 07410 201 797-2865

Helen Troum Nursery and Kindergarten at Temple Beth Sholom 40-25 Fair Lawn Ave, Fair Lawn, NJ 07410 201 797-2865 Helen Troum Nursery and Kindergarten at Temple Beth Sholom 40-25 Fair Lawn Ave, Fair Lawn, NJ 07410 201 797-2865 dlesnoytbs@yahoo.com Enrollment Contract and Registration Form 2016-2017 School Year I hereby

More information

Parent / Provider Contract

Parent / Provider Contract Ascension Before & After School Care Ascension is called to be a family of faith so reflecting the life of Christ, that we draw all people to Him. Parent / Provider Contract This contract is between, parent(s)

More information

Montessori Children s House Registration Form. Child s Name: Start date: Place of Employment. Place of Employment

Montessori Children s House Registration Form. Child s Name: Start date: Place of Employment. Place of Employment Montessori Children s House Registration Form Child s Name: Start date: Date of Birth: Nickname: Mother s Name: Mother s Address: Contact Numbers Place of Employment Work Address Work Phone Social Security

More information

2015-2016 APPLICATION PACKET

2015-2016 APPLICATION PACKET 2015-2016 APPLICATION PACKET Child s Name: Last Name First Name Middle Enrollment Procedure The parents and child will visit Palm Valley Montessori School for an interview with the director and/or administrator,

More information

Dear Corner Stone Charter Parent:

Dear Corner Stone Charter Parent: Dear Corner Stone Charter Parent: Welcome to Boll Family YMCA s School Age Child Care (SACC) program. We are looking forward to sharing the next 11 months with your child before and after school. Attached

More information

FAMILY CHILD CARE ENROLLMENT PACKET F A C E S H E E T

FAMILY CHILD CARE ENROLLMENT PACKET F A C E S H E E T Children s Records must be maintained for at least five (5) years after a child has left the program FAMILY CHILD CARE ENROLLMENT PACKET F A C E S H E E T Please fill out these forms completely. If a question

More information

Community Action Partnership of Lake County Head Start Program 1200 Glen Flora Waukegan, Illinois (847)

Community Action Partnership of Lake County Head Start Program 1200 Glen Flora Waukegan, Illinois (847) Community Action Partnership of Lake County Head Start Program 1200 Glen Flora Waukegan, Illinois 60085 (847) 249-4330 www.caplakecounty.org Thank you for your interest in the Head Start Program. Our program

More information

St. Patrick s School Extended Care Program

St. Patrick s School Extended Care Program Rev. 8.15 St. Patrick s School Extended Care Program Whoever welcomes one of these little children in my name welcomes me; and whoever welcomes me does not welcome me but the one who sent me Mark 9:37

More information

Annual Enrollment Application and Contract (For Preschool-age and older)

Annual Enrollment Application and Contract (For Preschool-age and older) Annual Enrollment Application and Contract (For Preschool-age and older) Child's Name: Date of Birth: Phone Number: City: State: Zip Code: Session (F)ull or (P)art Time Arrival Time Departure Time Rate

More information

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES 2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES CAMP LOCATIONS CAMP DATES/TIMES June 6 July 15, 2016 James J. Eagan Center (300) 9:00am 3:00pm Koch Park (320) No camp July 4th All Prices Subject

More information

Natalie Brutto Infant and Toddler Provider 840 Hayes St. Apt. 3 San Francisco, CA 94117 PH: 415-863-4642 Fax: 415-874-9282 nbrutto@aol.

Natalie Brutto Infant and Toddler Provider 840 Hayes St. Apt. 3 San Francisco, CA 94117 PH: 415-863-4642 Fax: 415-874-9282 nbrutto@aol. Natalie Brutto Infant and Toddler Provider 840 Hayes St. Apt. 3 San Francisco, CA 94117 PH: 415-863-4642 Fax: 415-874-9282 nbrutto@aol.com PARENT HANDBOOK Dear Parent/Guardian: Welcome to Giggles Galore!

More information

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address:

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address: ZION CHRISTIAN CHILDREN S CENTER SCHOOL AGE SUMMER CAMP Zion United Methodist Church ~ 1674 Zion Road Troy, VA 22974 (434) 906-5494 ~ ZionUMCAfterschool@gmail.com Registration 2012 Summer (Available 7am

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

CHITIMACHA TRIBAL SCHOOL. AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016

CHITIMACHA TRIBAL SCHOOL. AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016 CHITIMACHA TRIBAL SCHOOL AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016 After School Care Program Registration Please read and complete all information contained

More information

STEPS TO ADMISSION We recommend that interested parents schedule a campus tour.

STEPS TO ADMISSION We recommend that interested parents schedule a campus tour. So the generations to come might know Him Psalm 78:4 STEPS TO ADMISSION We recommend that interested parents schedule a campus tour. Application Process 1. Complete and return the application with the

More information

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl REGISTRATION FORMS Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Address: City: State: Zip Code: Child #1 Days of the

More information

Avon Seedlings Program 2015-2016 An Academic Preschool and Childcare Opportunity

Avon Seedlings Program 2015-2016 An Academic Preschool and Childcare Opportunity Avon Seedlings Program 2015-2016 An Academic Preschool and Childcare Opportunity REGISTRATION FORM I hereby apply for enrollment of my child in the Avon Seedlings Program. Child s Gender: Date of Birth:

More information

Peachtree Academy Home-School Collaborative Admissions Process

Peachtree Academy Home-School Collaborative Admissions Process Peachtree Academy Home-School Collaborative Admissions Process Step 1: Contact the Headmaster of Principal to discuss Home-School Collaborative course needs and expectations. Step 2: A parent/student interview

More information

PARENTING PLAN. This Parenting Plan Agreement is entered into by and between Petitioner * * *

PARENTING PLAN. This Parenting Plan Agreement is entered into by and between Petitioner * * * PARENTING PLAN OPTION 1: This Parenting Plan Agreement is entered into by and between Petitioner * * * (Father/Mother) and Respondent *** (Father/Mother). The parties have [no.] child/ren to which this

More information

First Baptist Church of College Hill

First Baptist Church of College Hill After School Application Applicant Information Please complete for the primary residence for the child. Child s Full Name: DOB: Date (of application): Street Address Apartment# City State ZIP Code Household

More information

Address: Street City State Zip Code Home Phone: E-mail Address:

Address: Street City State Zip Code Home Phone: E-mail Address: SANDWICH CUSD #430 REGISTRATION FORM SCHOOL YEAR 2013-2014 SELECT AN ATTENDANCE CENTER LG Haskin Prairie View WW Woodbury HE Dummer Middle School High School 1. NAME: 5. SEX: Male Female Last Name First

More information

Enrollment & Agreement/Policy Forms

Enrollment & Agreement/Policy Forms Enrollment & Agreement/Policy Forms Today s Date Day(s) of Week Care Needed Date Care to Begin Monday Tuesday Wednesday Thursday Friday Time(s) (write in beneath the day to which it pertains) Child s Full

More information

PERKINS CHILD CARE ASSISTANCE APPLICATION

PERKINS CHILD CARE ASSISTANCE APPLICATION Check ALL that apply: PERKINS CHILD CARE ASSISTANCE APPLICATION SEMESTER YEAR: 20_ SEMESTER YEAR: 20_ Fall Spring SI SII Fall Late Start Spring Late Start Spring Mini Please PRINT: Name: Address: ID #

More information

Burlington Kids Afterschool Program Registration Packet 2015-2016

Burlington Kids Afterschool Program Registration Packet 2015-2016 Welcome! Burlington Kids Afterschool Program Registration Packet 2015-2016 Welcome to the 2015-2016 Burlington Kids Afterschool Program, a collaboration between the City of Burlington, Parks, Recreation

More information

Join the Future Inspired Native American Leaders!

Join the Future Inspired Native American Leaders! Join the Future Inspired Native American Leaders! What is it? An exciting program that prepares American Indian high school youth to become college and career ready and learn about their culture! Who is

More information

THE NORTHEAST MISSISSIPPI COMMUNITY COLLEGE CHILD CARE CENTER APPLICATION

THE NORTHEAST MISSISSIPPI COMMUNITY COLLEGE CHILD CARE CENTER APPLICATION Date Received THE NORTHEAST MISSISSIPPI COMMUNITY COLLEGE CHILD CARE CENTER APPLICATION Classification Schedule A. Student Full-time M-F (Full-time 12 hrs.) B. Faculty/Staff Part-time M-TH MW TTH CHILD

More information

LEARN GROW THRIVE VANDERBILT YMCA Y-AFTER SCHOOL ACADEMY PROGRAM GUIDE 2014-2015 VANDERBILT YMCA

LEARN GROW THRIVE VANDERBILT YMCA Y-AFTER SCHOOL ACADEMY PROGRAM GUIDE 2014-2015 VANDERBILT YMCA LEARN GROW THRIVE VANDERBILT YMCA Y-AFTER SCHOOL ACADEMY PROGRAM GUIDE 2014-2015 VANDERBILT YMCA 224 East 47th Street New York, NY 10017 P 212-912-2500 ymcanyc.org/vanderbilt tinyurl.com/vanderbiltyfb

More information

FORREST COLLEGE CHILD CARE. Handbook

FORREST COLLEGE CHILD CARE. Handbook FORREST COLLEGE CHILD CARE Handbook MISSION STATEMENT We are privileged at Forrest College to provide free child care for the children of our fulltime students. It is our aim to provide a safe and structured

More information

Recreation & Community Services Camp Serendipity Summer Day Camp 2016

Recreation & Community Services Camp Serendipity Summer Day Camp 2016 Recreation & Community Services Camp Serendipity Summer Day Camp 2016 Camp Phone & Address Performing Arts Center (Youth Center) 800 Hobson Way (805) 385-8168 (Camp Site) (805) 890-6321 (Camp Site Cell)

More information

Dear Parents, RATES: Registration fee (non-refundable) $50.00*

Dear Parents, RATES: Registration fee (non-refundable) $50.00* Dear Parents, The Child Development Center staff at Northwest-Shoals Community College continuously works to provide the highest quality care for your preschool child. Our well-trained teachers provide

More information

Welcome Letter. Please request the current Tuition and Fee Schedule Form directly from the campus location you are interested in enrolling your child.

Welcome Letter. Please request the current Tuition and Fee Schedule Form directly from the campus location you are interested in enrolling your child. Welcome Letter Dear Parent, Thank you for considering Castle Montessori for your child! Castle Montessori's academic philosophy is based on authentic Montessori principles for students ranging from toddlers

More information

Daily Homework Help Time Outdoor Games Warm & Caring Environment Friendly & Qualified Staff Theme-Based Curriculum Arts & Crafts

Daily Homework Help Time Outdoor Games Warm & Caring Environment Friendly & Qualified Staff Theme-Based Curriculum Arts & Crafts GENERAL INFORMATION AFTER SCHOOL 2015-16 After School Programs are provided for youth who attend school in the Town of Amherst. The program operates Monday Friday from 2:00-5:30pm. An Extended Afternoon

More information

TUITION RATES SCHOOL YEAR 2015-2016

TUITION RATES SCHOOL YEAR 2015-2016 TUITION RATES SCHOOL YEAR 2015-2016 REGISTRATION FEE: $65.00 per child DISCOUNTS: Family discount apply to families with two or more children in the Extended Day program. Full price is paid for the youngest

More information

CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org

CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org REGISTRATION FORM (Please Print) STUDENT INFORMATION Student s last name: First:

More information

Class Age by June 1 st Age during school year Parent Toddler 2 months, under 3

Class Age by June 1 st Age during school year Parent Toddler 2 months, under 3 Westside Waldorf School Our Programs: Parent-Infant Toddler Class. For children from the age of 2 months to 3 years; classes meet 1 or 2 days per week in 10 to 12 week blocks throughout the year. All classes

More information

GCA Summer Camp 2016 Overview

GCA Summer Camp 2016 Overview GCA Summer Camp 2016 Overview Ages: Preschool to 6th Grade Registration Fee: FREE if registered by May 2nd; $15 per week if registered after May 2nd. Tuition Fee: $125 per weekly session.* This includes

More information

REGISTER TODAY! LOCATIONS: DES MOINES / PARKSIDE / NORTH HILL MARVISTA / MIDWAY / WOODMONT

REGISTER TODAY! LOCATIONS: DES MOINES / PARKSIDE / NORTH HILL MARVISTA / MIDWAY / WOODMONT RESERVE YOUR SPOT NOW! BEFORE AND AFTER SCHOOL PROGRAMS REGISTER TODAY! LOCATIONS: DES MOINES / PARKSIDE / NORTH HILL MARVISTA / MIDWAY / WOODMONT At your child s school site for ease and convenience Creative

More information

River Canyon School RIVER CANYON SCHOOL APPLICATION FOR ENROLLMENT. To be completed by parent or guardian.

River Canyon School RIVER CANYON SCHOOL APPLICATION FOR ENROLLMENT. To be completed by parent or guardian. River Canyon School Early Childhood Programs inspired by Waldorf Education River Canyon School 730 25 Rd Grand Junction, CO 81505 Contact us at 970-639-0514 or e-mail info@rivercanyonschool.com RIVER CANYON

More information

Extended Enrichment Kindergarten Program at YOUR Home School!

Extended Enrichment Kindergarten Program at YOUR Home School! Extended Enrichment Kindergarten Program at YOUR Home School! QUALITY CARE AT YOUR NEIGHBORHOOD SCHOOL ENRICH your child s early educational experience by EXTENDING his or her learning and fun right at

More information

We appreciate your interest in the Child Development Center and look forward to your family joining our family.

We appreciate your interest in the Child Development Center and look forward to your family joining our family. Dear Parent: We appreciate your interest in the Child Development Center and look forward to your family joining our family. Our application packet is attached. Please remove the "Child's Medical Report"

More information

Math + Leadership Camp at CSUSM Registration Forms

Math + Leadership Camp at CSUSM Registration Forms Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 Registration Checklist Complete all sections of

More information

Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas 78212. 210-732-6979 Fax 210-732-6392 APPLICATION FOR ADMISSION

Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas 78212. 210-732-6979 Fax 210-732-6392 APPLICATION FOR ADMISSION Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas 78212 210-732-6979 Fax 210-732-6392 APPLICATION FOR ADMISSION Child s name (last) (first) (middle) (name used) Sex Date of birth Place

More information

Before and After School Enrichment General Information, 2015-2016

Before and After School Enrichment General Information, 2015-2016 Before and After School Enrichment General Information, 2015-2016 Care Site/Title XX Authorization Schools Served Location Times DeWitt YMCA BASE DeWitt DeWitt Elementary 425 Falls Ave Cuyahoga Falls,

More information

Mulberry Waldorf School Enrolment Package 2016/2017

Mulberry Waldorf School Enrolment Package 2016/2017 Mulberry Waldorf School Enrolment Package 2016/2017 Dear Current and New Mulberry Families, Thank you for considering Mulberry Waldorf School for your child s education. We invite you to get to know more

More information

Application Summer Study - Pre-College New York Summer Study 2016

Application Summer Study - Pre-College New York Summer Study 2016 Application Summer Study - Pre-College New York Summer Study 2016 First Name Birth Date (Month/Day/Year) Address Last Name Male Female City State Zip/Country code Country Home Tel. E-mail Current School

More information

Extracurricular Activities Handbook

Extracurricular Activities Handbook Extracurricular Activities Handbook Board Approved July 16, 2007 EXTRA-CURRICULAR STUDENT ACTIVITIES HANDBOOK Philosophy and Definition Extra-curricular activities are school-sponsored activities that

More information

Camper Information Form

Camper Information Form Camper Information Form NO CAMP HELD ON JULY 4, 2016 Please Mark Dates Attending: Session 1: June 27 July 8 Session 2: July 11 July 22 Session 3: July 25 August 5 ALL 3 SESSIONS Personal Information Name

More information

ENROLLMENT INSTRUCTIONS

ENROLLMENT INSTRUCTIONS ENROLLMENT INSTRUCTIONS Thank you for your interest in Little Tyke Creative Child Care. The steps below will walk you through our online enrollment process: STEP 1 Contact one of the center directors in

More information

AFTER SCHOOL PROGRAM CHILD'S FACE SHEET/ENROLLMENT FORM

AFTER SCHOOL PROGRAM CHILD'S FACE SHEET/ENROLLMENT FORM CHILD'S FACE SHEET/ENROLLMENT FORM CHILD INFORMATION Child's Name: Date of Birth: Home Address: Telephone: School attending for 2014/15 school year: Primary Language: Child's Identifying Information (required

More information

Know the Law About Who May Pick Up a Child from Child Care

Know the Law About Who May Pick Up a Child from Child Care Know the Law About Who May Pick Up a Child from Child Care In California, part of a child care provider s legal responsibility for the children in her care is an obligation to let the child leave only

More information

Oberlin Dance Intensive

Oberlin Dance Intensive Oberlin Dance Intensive July 6-11, 2014 For Ages 14-18 Early Registration Deadline: March 1, 2014 = $585 tuition Regular Registration Deadline: April 10, 2014 = $625 tuition Email completed registration

More information

YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM

YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM Branch: North Brooklyn YMCA Camp Site: North Brooklyn Branch Camp Type: PARTICIPANT INFO Child s Name Age D.O.B. Gender Grade in September 2016 School

More information

UNIVERSITY OF NEBRASKA AT OMAHA CHILD CARE CENTER CONTRACT/AGREEMENT

UNIVERSITY OF NEBRASKA AT OMAHA CHILD CARE CENTER CONTRACT/AGREEMENT UNIVERSITY OF NEBRASKA AT OMAHA CHILD CARE CENTER CONTRACT/AGREEMENT I agree to pay on the first day my child(ren) attends the center, a weekly tuition fee of $, with no deductions for absences or non-major

More information

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail.

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail. OUR CAMPS ARE FOR GIRLS AND BOYS (AGES 5 THRU 14) Visit our website at Junior Golf Camp (9:00am 12:30pm) We start camp early (8:45am) on Monday for check-in and orientation. The camp is designed for beginners

More information

Back-Up Care Advantage Program Registration Materials

Back-Up Care Advantage Program Registration Materials Registration Materials Dear Parent, Welcome to the Back-Up Care Advantage Program! An important part of preparing for a day of back-up care is ensuring that your care provider will have the information

More information

James Madison Charter Academy 2015 2016 Online Registration Instructions

James Madison Charter Academy 2015 2016 Online Registration Instructions James Madison Charter Academy 2015 2016 Online Registration Instructions Read all instructions before completing registration packet All families are required to register online for SY 2015-16. Complete,

More information

MIDDLE SCHOOL ACADEMIC ENRICHMENT PROGRAM REGISTRATION FORM 2015-2016

MIDDLE SCHOOL ACADEMIC ENRICHMENT PROGRAM REGISTRATION FORM 2015-2016 MIDDLE SCHOOL ACADEMIC ENRICHMENT PROGRAM REGISTRATION FORM 2015-2016 * Each form must be accompanied by a NON-REFUNDABLE, NON-TRANSFERABLE 10% deposit * Registration begins Monday, April 27, 2015 * Registration

More information

APPLICATION FOR ENROLLMENT SCHOOL YEAR Page 1

APPLICATION FOR ENROLLMENT SCHOOL YEAR Page 1 Page 1 Name of Student: Grade: Items (6) needed to confirm enrollment into the Academy: 1. Official Birth Certificate or copy and Social Security Card or copy (not just the number) 2. Complete immunization

More information

ENROLLMENT AGREEMENT

ENROLLMENT AGREEMENT ENROLLMENT AGREEMENT Completion of this Agreement is required for enrollment. This information is necessary for First Steps Early Childhood Learning Center to comply with the State of Missouri Child Care

More information

2016 SUMMER DAY CAMP REGISTRATION YMCA OF BEAUFORT County SITE LOCATION

2016 SUMMER DAY CAMP REGISTRATION YMCA OF BEAUFORT County SITE LOCATION $15 Online Registrations / family $25 In person Registration / family Weekly Fees: Please see Camp Brochure 2016 SUMMER DAY CAMP REGISTRATION YMCA OF BEAUFORT County SITE LOCATION I have attached a valid

More information

Toronto International Student Programs STUDENT APPLICATION FORM

Toronto International Student Programs STUDENT APPLICATION FORM Toronto International Student Programs STUDENT APPLICATION FORM Please submit completed application form to: Toronto District School Board International Students and Admissions Office 5050 Yonge Street,

More information

2014-2015 Enrollment Packet

2014-2015 Enrollment Packet 2014-2015 Enrollment Packet Please review the information below. Based on your student (s) grade and applicable circumstances, you are required to submit documentation in order to complete this step in

More information

Hilo, Hawaii Summer School 2015 Physical Education 9, Fitness 4 Life !!!

Hilo, Hawaii Summer School 2015 Physical Education 9, Fitness 4 Life !!! St. Joseph Jr-Sr High School Hilo, Hawaii Summer School 2015 Physical Education 9, Fitness 4 Life Fitness 4 Life, a course designed for students to discover, understand and realize the importance of physical

More information

PROJECT EXCEL MENTORING PROGRAM Creating Vision Through Mentoring / What They See is What They Will Be

PROJECT EXCEL MENTORING PROGRAM Creating Vision Through Mentoring / What They See is What They Will Be Personal Information Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father other, specify: Street Address: City: State:

More information

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program.

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program. VALOR Before/After School Program School Year 2016-2017 Mar Vista Academy Enrollment Form and General Release for the Before/After School Program State and Federal Programs Student First Name Middle Name

More information

CAO FL-3 PARENTING PLAN. The parents (Father) and (Mother) shall spend time with their children: Date of Birth

CAO FL-3 PARENTING PLAN. The parents (Father) and (Mother) shall spend time with their children: Date of Birth CAO FL-3 PARENTING PLAN The parents (Father) and (Mother) shall spend time with their children: Name as follows: Date of Birth 1. PARENT RESPONSIBILTIES When each child is in a parent s physical custody,

More information

2016 CAMP DISCOVERY REGISTRATION

2016 CAMP DISCOVERY REGISTRATION 2016 CAMP DISCOVERY REGISTRATION We must have 2 weeks written notice prior to a child canceling camp or you will be charged the full amount Please print all information clearly (blue or black pen only)

More information

Early Learning Center for Research and Practice Parent Handbook Policies. Inclement Weather Policy

Early Learning Center for Research and Practice Parent Handbook Policies. Inclement Weather Policy Inclement Weather Policy The University of Tennessee does not close except in the most severe weather conditions. In most cases, the Early Learning Center will comply with the University of Tennessee s

More information

Join the Future Inspired Native American Leaders Program!

Join the Future Inspired Native American Leaders Program! Join the Future Inspired Native American Leaders Program! What is it? An exciting program that prepares American Indian high school young men to become college and career ready and learn about their culture!

More information

Summer Recreation Program

Summer Recreation Program Great Neck Public Schools 70 th Annual Summer Recreation Program Summer 2016 Kindergarten to Fifth Grade Tuesday, July 5 - Friday, August 12 9:15 am 3:15 pm IMPORTANT INFORMATION Program Students Grade

More information

Parenting Plan Worksheet

Parenting Plan Worksheet 1001 SW 5 th Ave., Suite 1300 Portland, OR 97204 Voice: (503) 546-6374 Fax: (503) 546-6376 TF: (866) 336-9346 Parenting Plan Worksheet Please complete the following worksheet. You may want to review the

More information

Relationship to volunteer applicant:

Relationship to volunteer applicant: Bristol Hospital Junior Volunteer Program Parental Consent Form In order for your child to become a volunteer with us, we need your consent and your involvement in helping them have a productive experience.

More information

PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER SCHOOL CARE PROGRAM 2013/2014

PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER SCHOOL CARE PROGRAM 2013/2014 Dedicated to providing a high quality education to a diverse community where all students are expected to succeed as life-long learners. PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER

More information

THIS APPLICATION WILL NOT BE ACCEPTED IF IT IS ALTERED IN ANY WAY

THIS APPLICATION WILL NOT BE ACCEPTED IF IT IS ALTERED IN ANY WAY Welcome To Crafton Hills College If you are downloading the High School Concurrent Enrollment Request form but haven t applied for admission online, you must do so to receive your Student ID number. Students

More information

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION. D.O.B. SEX: GRADE (in Sept.

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION. D.O.B. SEX: GRADE (in Sept. WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION CHILD NAME: ADDRESS: CITY: D.O.B. SEX: GRADE (in Sept. 2015): MOTHER S NAME: ADDRESS: CITY: STATE:

More information

City of Hialeah Education & Community Services Department Young Leaders of Character Program PROGRAM HANDBOOK

City of Hialeah Education & Community Services Department Young Leaders of Character Program PROGRAM HANDBOOK City of Hialeah Education & Community Services Department Young Leaders of Character Program PROGRAM HANDBOOK MISSION STATEMENT It is the intention of The City of Hialeah to provide a safe, positive, and

More information

Centennial Family Medicine & Wellness PATIENT DEMOGRAPHIC INFORMATION FORM Patient s Full Name (List all name if more than one child)

Centennial Family Medicine & Wellness PATIENT DEMOGRAPHIC INFORMATION FORM Patient s Full Name (List all name if more than one child) Centennial Family Medicine & Wellness PATIENT DEMOGRAPHIC INFORMATION FORM Patient s Full Name (List all name if more than one child) Physician: Date of Birth Gender Social Security PARENT/GUARDIAN S NAME:

More information

LOCAL PARENTING PLAN AND COMPANIONSHIP SCHEDULE Court of Common Pleas, Wood County, Ohio Domestic Relations Division / Juvenile Division

LOCAL PARENTING PLAN AND COMPANIONSHIP SCHEDULE Court of Common Pleas, Wood County, Ohio Domestic Relations Division / Juvenile Division Revised August 4, 2008 LOCAL PARENTING PLAN AND COMPANIONSHIP SCHEDULE Court of Common Pleas, Wood County, Ohio Domestic Relations Division / Juvenile Division Parenting time is a time for children to

More information

RARITAN BAY AREA YMCA

RARITAN BAY AREA YMCA Dear Applicant, Enclosed please find the Youth Leaders & Junior Counselor In Training Application and the Camp Registration Packet. Please complete the application and return all documents with your $100.00

More information

SUMMER ZOO CAMP 2016

SUMMER ZOO CAMP 2016 Scholarships are non-transferable INDIVIDUAL ZOO CAMP SCHOLARSHIP SUMMER ZOO CAMP 2016 APPLICATION AND GUIDELINES APPLICATION DEADLINE March 18, 2016 1 2016 SCHOLARSHIP GUIDELINES Thank you for your interest

More information

ROSE BOWL AQUATICS CENTER

ROSE BOWL AQUATICS CENTER ROSE BOWL AQUATICS CENTER WELCOME TO THE ROSE BOWL AQUATICS CENTER PRIVATE LESSON PROGRAM Welcome to the Rose Bowl Aquatics Center. We are happy to have you become a member of our private lesson family.

More information

WAYNE COUNTY CIRCUIT COURT CO-PARENTING ORDER GENERAL PARENTING TIME

WAYNE COUNTY CIRCUIT COURT CO-PARENTING ORDER GENERAL PARENTING TIME WAYNE COUNTY CIRCUIT COURT CO-PARENTING ORDER GENERAL PARENTING TIME PURPOSE OF PLAN: The following Plan is for use when the custodial parent (CP) and non-custodial parent (NCP) live close to each other,

More information

FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT

FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT This contract is to be signed by both the participant (child) and his or her parent/guardian. This ensures that both the child and the adult understand

More information

BOOSH Handbook. Welcome to BOOSH! Before and After School Care Vacation Care

BOOSH Handbook. Welcome to BOOSH! Before and After School Care Vacation Care phone: 0438 099 006 or 4787 7150 email: boosh@banc.org.au website: www.banc.org.au/blackheath-out-of-school-hours-boosh parent portal: https://banc.hubworks.com.au/ Welcome to BOOSH! BOOSH Before and After

More information

SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET

SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET School / Team: Name: Address: City, State, Zip: Home Phone: Cell Phone: Email: (please circle your responses) Do you attend the above named

More information

New Student Registration Forms. Registration Checklist

New Student Registration Forms. Registration Checklist New Student Registration Forms Registration Checklist To be completed only if offered a spot Please print these registration documents All forms should be completed in full The following list includes

More information

Pierce Memorial Baptist Nursing & Rehab Center, 44 Canterbury Road, Brooklyn CT 06234 (860) 774-9050 www.piercecare.org

Pierce Memorial Baptist Nursing & Rehab Center, 44 Canterbury Road, Brooklyn CT 06234 (860) 774-9050 www.piercecare.org Dear Applicant of PierceCare PierceCare has been caring for the elderly of the state of Connecticut for over 50 years. Our priorities are to provide for those elderly who need extra care, supervision or

More information

WATONGA ELEMENTARY SCHOOL 900 North Leach Main Office: (580) 623-5248 P.O. Box 640 Facsimile: (580) 623-5238 Watonga, Oklahoma 73772

WATONGA ELEMENTARY SCHOOL 900 North Leach Main Office: (580) 623-5248 P.O. Box 640 Facsimile: (580) 623-5238 Watonga, Oklahoma 73772 WATONGA ELEMENTARY SCHOOL 900 North Leach Main Office: (580) 623-5248 P.O. Box 640 Facsimile: (580) 623-5238 Watonga, Oklahoma 73772 Website: www.watongapublicschools.com 2014-2015 STUDENT ENROLLMENT INFORMATION

More information