Hudson Hills Academy
EnrollmentContract
Child’sFull Legal Name(Last)(First)(Middle)
Child’sDate of BirthProgram ( Toddler, Primary, Kindergarten, Elementary, Middle School)
Primary 3 & 4 year olds only: __5 full or __5 half or indicate full or half for each day of the week ___Mon ___Tue ___Wed ___Thu___Fri
Parent/GuardianBilling Information
Parent 1Name(Last)(First)Work PhoneHomePhone
Parent 1AddressCityStateZip
Parent 1E-MailAddress
Parent 2Name (Last)(First)Work PhoneHomePhone
Parent 2AddressCityStateZip
Parent 2 E-MailAddress
Choose yourPayment Plan:__Monthly orEmail invoice to: ______
___Annual (5% discount if paid before 9/1/15 for School Year 2015-2016) Address if different from above: ______
______
Choose yourPayment Method:
___Check___ Money Order/Cashier’sCheck___Cash
___ CreditCard ____DiscoverCard ___MasterCard _____VISA
(NewCreditCardformmustbefilledout30dayspriortoeachexpirationdateofthecardonfile.)
Name on card______Card #______
Exp. Date______CVV# ______
PrintNameSignature ofParent/PersonContractuallyResponsibleDate
PrintNameSignature ofParent/PersonContractuallyResponsibleDate
Authorized School Official
Date
Hudson Hills Academy
ContractTermsandConditions
Initials
Initials
Initials
Initials
Initials
Initials
Initials
Initials
Initials
Initials
Initials
Initials
1.Asusedhereintheword"I"referstoeachparentorguardiansigningthiscontract.Theobligationofeachpersonsigningthiscontractisjointandseveral.
2.IunderstandthataNon-RefundableApplicationFeealongwiththetuitionandfeesasindicatedarerequiredforallstudentsandmustbeenclosedwiththiscontractinorderformychildtobeenrolled.
3.IunderstandandagreetoabidebythepoliciesandproceduresassetforthintheHudson Hills Academy Parent/StudentHandbook;includingtheparentcodeofconductand/orchangesorrevisionstoschoolpoliciesaspostedonourwebsite.Iamawarethattheschoolmustfollowstrictpoliciesregardinghealthandsafetyregulations,DepartmentofEducation,andtheDepartmentofSocialServices guidelines. Iunderstandthatpoliciesandproceduresaresubjecttochangeandagreethatitismyresponsibilitytostayinformedthroughreadingnewsletters, the school websiteandparentbulletinboards.
4.IunderstandandagreethatHudson Hills Academyreservestherighttoreviewtheparent'srelationshipwiththeschoolandtosetreasonableconditionsforaccesstotheschool.Iamawarethattheschoolhasnoobligationorauthoritytoenforcecustodyorparentvisitationissueswithoutcourtdocumentstosupportit,andthattheschoolreservestherighttocontacttheappropriateauthoritiesshoulddisputesofthistypearise.Ifurtheragreetoholdtheschoolharmlessforanycontactrelatedthereto.
5.Iunderstandandagreethattherearespecificareasoflegitimateparentalconcern.Theseincludemychild'scourse
work,academicprogress,behavior,andphysicalsafety.Imayfeelfreeatanytimetodiscusstheseissueswiththeschooladministration.Ifurtherunderstandthatthereareareasofschoolpolicywhicharenotsubjecttomycontrol,includingpersonnelhiringandtermination,personnelcontractualissues,andotherpoliciesandproceduresestablishedbytheadministration.
6.Iagreetofurnishallenrollmentformsandcontracts,proofofcurrentimmunizations,medicalinformationandallemergencyformsrequiredbyNew York Stateandtheschoolbeforethefirstdayofclass.Iunderstandthatfailuretodosomayresultinaninterruptioninmychild’sattendancewithoutanyreductioninfees.
7.Iamawarethemonthlypaymentplanincludesalatefeeof$100.00permonthforpaymentsnotmadebeforethe10thofeachmonth. Hudson Hills Academy reservestherighttosuspendastudentanytimethattuitionpaymentsbecomemorethan30daysdelinquent.
8.Feesforallextracurricularclasses/eventsmustbepaidbeforethechildcanbeacceptedtoattend.Whentuitionpaymentsareinarrears,thestudentmaynotparticipateinschool-sponsoredactivitiesincludingbutnotlimitedtofieldtrips,shows,programs, studios, after care etc.
9.IamawarethatImustgiveafull30daywrittennoticeofanychangesinschedule,ormethodofpayment.IntheeventofwithdrawalfromHudson Hills Academyandafterthechildhasmetthe30dayadjustmentperiod,(atotalof60days
minimumenrollment)IamawarethatIamresponsibleforthefull,paid30dayswrittennotice.However,ifmychildisenrolledintheelementaryand middle school level, IunderstandthatanywithdrawalafterMarch31stofeachschoolyear,Iwillberesponsiblefortuitionandfeesuntiltheendoftheacademicyear(June30th).Iunderstandthattheschoolrecordsofmychild/childrenwillnotbe released until my account is paid in full.
10.IunderstandthatHudson Hills Academymayterminateenrollmentofmychildandstartcollectionproceedingsifanoutstandingbalanceremainsunpaidandattainsdelinquentstatus.IunderstandandagreethatIwillbeheldresponsibleforallcosts,expensesandinterestatthecurrentlegalrate,includingbutnotlimitedto,attorneyfees,collectionagencyfeesandcourtcostsincurredbyHudson Hills Academy inordertoremedyanybreachofthiscontract.
11.Iamawareofthefollowingnon-refundableannualfees:Registration and MaterialFees.Theannualfeesaregoodforonecontinuousenrollmentperiod.IfIdecidetowithdrawmychildforanyreasonandwishtoreturnatalaterdate,thenalltheenrollmentfeeswillbere-assessed.AFallReservationformandfeeisrequiredbyMarch15th toassuremychild'sspaceforthefollowingSchoolYear. Ialsounderstandthattherewillbenopro-ratingofanyannualfees.
12.Hudson Hills Academy reserves the right to change or revise any policy pertaining to the operation of the school with 30 days notice.
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DatePrintNameSignature of Parent/PersonContractuallyResponsible
_*Date / PrintName / Signature of Parent/PersonContractuallyResponsible / Authorized School Official