GOSHEN CHRISTIAN MONTESSORI SCHOOL, LLC
113 S. 6th St. Apt. 1 Goshen, IN 46528 (574) 596-0782
Enrollment Form
Student Information
Student’s Full NamePreferred Name
AddressCity StateZip
Birth date Age as of Sept.6, 2016 Is the student potty trained?
Name(s) of previous daycare/schools attended______
Who is the primary daytime care provider? ______
Where did you hear about Goshen Christian Montessori School? ______
This class runs 11:45-2:30pm Tuesday, Wednesday, and Thursdays for ages 33 months-6 years old. We follow Goshen Community Schools in holidays and breaks as well as weather related closings, delays, and early releases. Our school year runs Sept. 6, 2016-May 25, 2017.
Mon. and Fri. classes, as well as before and/or after school care may become available, based on demand, but is not guaranteed. If you are interested in additional care times/days for your child, please list them below: ______
Responsible Parties
Mother’s Full NameFather’s Full Name
AddressAddress
CityStateZipCityStateZip
Employer/OccupationEmployer/Occupation
Home Phone/Cell PhoneHome Phone/Cell Phone
Work PhoneWork Phone
Email AddressEmail Address
Enrollment Understanding
I (we) understand that, upon receiving confirmation of acceptance of this enrollment form by GCMS administration, this child will be enrolled at Goshen Christian Montessori School for the full academic school year. Enrollment is secured by annual contract. A $100.00 registration fee must accompany this form. Tuition and fees are non-refundable. Notice of withdrawal requires a 30-day prior written notice and must be approved by the school director. Accounts withdrawing from class during the school year will incur a $135 closing fee. Tuition may be paid in full or may be divided into monthly payments that are due by the first of each month, beginning Sept. 1, 2016, with a final payment due May, 1st 2017. A $35.00 NSF charge will be applied to all bounced checks. Tuition received after the 1st day of each month is late and will incur a $20 late fee. Accounts that are 30 days past due will not be allowed to send students to GCMS until payment is made. Families of students who are picked up from school after 2:35 will incur a $2.00 per minute late fee. Families of students who are picked up after our closing time of 2:45 pm will incur an additional $10 fee.
The Goshen Christian Montessori School enrolls students without regard to race, color, religion, gender, or national origin. All students are enrolled on a trial basis. The school reserves the right to ask a parent to withdraw a child from school if it is the opinion of the staff that the child is not a good fit or has a negative influence on the class.
Tuition is $165 per month, or, you may pay $1,485 for the full year by Sept. 1st. (For families with two siblings enrolled, tuition is $313.50 monthly/$2,821.50 for the year.)
The following is needed to complete enrollment:
A $75.00 materials fee which helps cover the cost of classroom materials, crafts, and cleaning supplies
A signed Enrollment Form, accompanied by a non-refundable $100.00 registration fee
2 wallet sized photos of student
A set of season appropriate spare clothes (incl. underwear and socks) in a large zip-lock bag with student’s name, and a set of slippers the child can pull on easily should be sent with the student on the first day of school. Backpacks should be sent with the students on Thursdays to take home any projects they've worked on through the week. Students that are still potty training should bring a set of diapers/pull ups and wipes.
(Please check one bubble, fill in the appropriate tuition amount and the responsible paying party’s signature)
o I will pay ______monthly tuition payment to Goshen Christian Montessori by the 1st of each month, from September 2016 through May 2017.
o I will pay the year's tuition ______by September 1st, 2016.
Signature (responsible paying party)Date
Print Full Name(print phone number if not previously listed)
(We highly recommend you keep a copy of these forms for your personal records.)
GCMS Emergency Contact Information
Please list who you would like us to contact regarding your child. Please list phone numbers at which your emergency contacts may be reached during school hours, so that we are able to speak with a contact as quickly as possible.
Student’s Name:______
#1 Contact person and phone______
Alternative phone number______
#2 Contact person and phone______
Alternative phone number______
#3 Contact person and phone______
Alternative phone number______
Please write your child’s doctor and phone number:______
Write any additional people you'd like us to reach:______
If your child has any allergies, special conditions, or phobias, please list them in detail here: ______
We will only let people listed below pick up your child, (unless you send a note or message that they're to go with someone else with a description of them and their vehicle prior to dismissal). Please list those that will be regularly be at dismissal.
Name & vehicle description ______
Name & vehicle description ______
Name & vehicle description ______
Parent’s Signature and date:______