32340 Electric Boulevard
Avon Lake, OH 44012
Telephone: (440) 933-7646
Email:
Julie Erker, Director
Registration Form
Today’s Date: ______
Child’s D.O.B:______
Child’s Full Name: ______
Parent’s Name (s): ______
Address: ______
Street City Zip
Telephone: ______Cell: ______Previously Enrolled? ____Yes ____No
Email address: ______
ADMISSION POLICY: The number of participants is limited, so enrollment is based on a first-come, first-served
basis.
There is a $50.00 non-refundable registration fee for each child.
The registration fee must accompany this form to confirm enrollment in an assigned class.
*Please be aware there is a price difference between A.M. vs. P.M. classes
CLASS DESIRED: PLEASE INDICATE 1ST AND 2ND CHOICE
2 1/2 –YEAR OLDS: 2 days-$150.00 & 3 days-$170.00 a month 3- YEAR OLDS: 2- days $110 & 3-days $150.00 a month
Child must be 30 months of age by Sept. 1, 2017 Child must be 3 years of age by Sept. 1, 2017
Mon/Wed/Fri 8:45 – 11:15 A.M. ____ Tues/Thurs 8:45 – 11:15 A.M.____
Tues/Thurs 8:45 - 11:15 A.M. ____
3 YEAR OLDS: A.M.-$150.00 & P.M.-$135.00 a month4-YEAR-OLD: A.M.-$190.00 a month
Child must be 3 Sept. 1, 2017 Child must be 4 years of age by Sept. 1, 2017
Mon/Wed/Fri 8:45 – 11:15 A.M.____ Mon/Tues/Wed/Fri 8:45 – 11:15 A.M.____
Tues/Thurs/Fri 8:45-11:15 A.M.____
Mon/Wed/Thurs12:15-2:45 P.M.____
4 ½ & 5-YEAR OLD PRE-K: A.M.-$190.00/P.M.-$170.00 4 YR OLD & PRE-K EXTENDED ENRICHMENT: 80.00 a month
Child must be 4 ½ years of age by Sept. 1, 2017 This class will take place before or after a regular class day on
Mon/Tues/Wed/Fri8:45-11:15 A.M.____ ThursdayorFRIDAY. Making Thursday or FridayONE FULL DAY
Mon/Tues/Wed/Thurs12:15-2:45 P.M.____ of school. It will include Lunch Bunch. ____
3 & ¾ ENRICHMENT CLASS: $55.00 a month LUNCH BUNCH: 2 days-$30, 3 days-$40, 4 days-$50
3, 3 ½ & 4-year-old PM class can sign up for this class. *if your child is signed up for the extended enrichment day make
Thursday 8:45 – 11:15 A.M.____ sure you subtract a day of lunch bunch
Friday 8:45- 11:15 A.M.____ 11:15 A.M.-12:15 P.M. 2____3____4____5____
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FOR OFFICE USE, ONLY:
Reg. fee paid by:Cash______Check______(Check #______) Date Payment Received: ______
*Wait List Number: 2 ½____ 3____ ¾____ Pre-K____ Enrollment Date: ______