Date of Inquiry ______Applying for School Year 2015/16______Application Fee- $30 included _____
Name of Child______Sex ______Birth date ______
How did you hear about our program?______Circle if your child is: currently enrolled sibling
Mother’s Name ______Phone ______
Address ______Work Phone ______
(City, Zip) ______
Email______
Father’s Name ______Phone ______
Address ______Work Phone ______
(City, Zip) ______
Email______
Days of the Week / 2 Year Old Class / 3 & 4 Year Old Class / After School Program3-10 yr olds
Mon / Wed / Fri / 8:15 – 11:15 AM $400/mo / 8:15 -12:15 AM
$505/mo * 3 yr olds / 3:30 PM-5:45 PM $232/mo
Tuesday/ Thursday / 8:15-11:15 AM $280/mo / 8:15AM -12:15 PM $345/mo * 3 yr olds / 3:30 PM- 5:45 PM $154/mo
Monday-Friday Afternoons
(Any afternoons) / 12:30-3:30 PM $125/mo (per afternoon added)
* 2 yr old or 3 yr old class / 12:30-3:30 PM
M, T, W, TH, F $575/mo
* Prek 4/5 yr olds / 3:30 PM- 5:45 PM $348/mo
M-F After School
3:30 PM-5:45 PM $278/mo Any 4 days After School
Lunch Bunch / 11:15 AM -12:15 PM
$10 per session $36/mo (per day added) / 11:15 AM-12:15 PM
$10 per session $36/mo (per day added) / Not Available
Mon / Wed / Fri All Day / 8:15 AM-3:30 PM $850/mo / 8:15 AM-3:30PM $850/mo / Not Available
Tues/ Thurs All Day / 8:15 AM- 3:30 PM $602/mo / Not Available / Not Available
**Family/Sibling/Twin discount of 15% off one child**
Please choose option(s):
1st Choice______2nd Choice______
Signature ______Date ______
Application Fee of $30 upon receipt of this form / Supply Fee of $50 due 6/1/15 / Acceptance Letters for current students: 2/16/15 / Acceptance Letters for Waitlisted students:3/23/15Paid & Staff Initial: / Paid & Staff Initial: / Signed Contracts & 1st month Deposit due3/18/15
Paid & Staff Initial: / Signed Contracts & 1st month Deposit due 4/6/15
Paid & Staff Initial: