K-5th Before & After care SCHOOL YEAR ONLY

Student Name*

Date Of Birth*

Gender*

Male

Female

Admission Type*

New Student?

Continuing Student?

Sibling Enrolled

Sibling Enrolled?

Requested Start Date:*

Address*

Street Address City ZIP Code

Home Phone*

Email*

Parent/Guardian*

Cell*

Employer*

Work Phone*

Parent/Guardian

Cell

Employer

Work Phone

Preferred Contact Email

Enrollment Procedures:

Submit a completed application and the required, non-refundable $130 Admissions Fee per family.
If space is not available when you apply for admission, you may submit a completed application and the non-refundable wait list fee of $30. The wait list fee is credited to the family’s admissions fee when a space is offered, and the family enrolls in our program. If space becomes available prior to your requested start date, monthly tuition payments will be required to hold the space

After acceptance, secure an enrollment packet from the Director and return the following completed items to the center within three days of acceptance.
a) Read, sign and initial pages of the Enrollment Contract and ACH Debit Authorization Form with voided check.
b) Non-refundable Material Fees & Deposit due by personal check or money order payable to Academy along with contract.

*All required forms must be completed and on file one month prior to start date. Children will not be permitted to attend without a complete file.

Academy welcomes children of all abilities to our program. If your child has a qualifying disability, including a special health need, that requires a special accommodation or modification, you must notify the Center Director in writing prior to your child’s start date

Academy has a non-discriminatory Admissions Policy and enrollment is on a trial basis.

Parent/Guardian Signature:*

Date:*

Parent/Guardian Signature:

Date:

Office Use Only:Admissions Fee: $130 Ck#: ________ Date: ____________ Staff Initial: _________ Materials Fee: $ Ck#: _______ Date: __________ Program Requested: _________________________ Deposit: $_____ Ck#: ________ Date: __________ Wait List? Yes or No Ck#: ______ Date: __________ Vouchers? Yes or No If yes, select one of the following approved fee assistance programs (check one): _____ MD CCSP _____ MoCo WPA _____ Military/DOD Child Care Assistance _____ FEEA Voucher Amount: $__________ Monthly or Weekly? ____________

Student’s Name*

Grade in Fall*

Please select program requested by placing a check mark in the appropriate box below and then sign and date the bottom of this page. Program options are limited by group size and ratio requirements.

Has your family applied to FARMS?*

Yes

Has your family applied to Maryland CCS or WPS Vouchers?*

Yes

INSTALLMENT PAYMENTS

Schedule Options*

Before & After Extended Days (7:00 a.m. – 6:00 p.m.)

Before School Only (7:00 a.m. – 9:25 a.m.)

After School Only (3:50 p.m. – 6:00 p.m.)

Before & After Extended Days (7:00 a.m. – 6:00 p.m.)*

When Academy is open

$555 monthly [M-F]

$405 monthly [3 Days, Circle Days: M, T, W, TH, F]

$280 monthly [2 Days, Circle Days: M, T, W, TH, F]

Before School Only (7:00 a.m. – 9:25 a.m.)*

Only when MCPS is open

$315 monthly [M-F]

$210 monthly [3 Days, Circle Days: M, T, W, TH, F]

$150 monthly [2 Days, Circle Days: M, T, W, TH, F]

After School Only (3:50 p.m. – 6:00 p.m.)*

Only when MCPS is open

$440 monthly [M-F]

$305 monthly [3 Days, Circle Days: M, T, W, TH, F]

$210 monthly [2 Days, Circle Days: M, T, W, TH, F]

Non-Refundable Fee Schedule:

Wait List Fee - $30 (part of the Admissions Fee)
Admissions Fee - $130
Materials Fee - $250 for 5 days; $120 for 3 days; $90 for 2 days
Before School Only Programs - $50 for 5 days; $30 for 3 days; $20 for 2 days

Tuition Guidelines:

Tuition is an annual fee that is due prior to the start of the school year. A discount will be applied if the annual tuition is paid in full by August 1st.
There is an option to pay in equal, non-refundable monthly tuition installments. The first installment is due August 1st and the last installment is due May 1st.
Applications received after August 1^s :
1. Will owe the first and last non-refundable tuition installments or
*2. A non-refundable deposit of *$150 (that will be applied towards the last-non-refundable tuition installment) and first non-refundable tuition installment. *When choosing option #2, parents will be responsible for the remaining balance of their last installment once the deposit has been applied.
Contact Center Director for payment plan options.

Parent/Guardian Signature*

Date*

Parent/Guardian Signature

Date

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School-Year Only Program (August 30, 2021 – June 15, 2022)
(PreK-5th Grade)

Enrollment Procedures:

INSTALLMENT PAYMENTS

Non-Refundable Fee Schedule:

Tuition Guidelines:

Have Questions?

K-5th Before & After care SCHOOL YEAR ONLY

School-Year Only Program (August 30, 2021 – June 15, 2022)(PreK-5th Grade)

Enrollment Procedures:

INSTALLMENT PAYMENTS

Non-Refundable Fee Schedule:

Tuition Guidelines:

Have Questions?

School-Year Only Program (August 30, 2021 – June 15, 2022)
(PreK-5th Grade)