SUMMER ONLY APPLICATION 2021 - Preschool & Childcare Center Serving Gaithersburg, North Potomac, Potomac, Rockville & Silver Spring, MD

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 Procedure:

1. 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 (listed on Tuition Worksheet) due by personal check or money order payable to Academy.

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*

Please select your child’s age group and program requested by placing a checkmark in the appropriate boxes below. Read the tuition guidelines, sign and date at the bottom of this page. Program options are limited by group size and ratio requirements.

Which Age Group is your child?*

Preschool (child must be 3 years old on or before September 1, 2021)

PreKindergarten (child must be 4 years old on or before September 1, 2021)

Is your child toilet trained?*

Yes

Almost

Must be 3 or 4 years of age on or before September 1, 2020 of the current school year to be age eligible for admission to the school program. (Child must be toilet trained.)

Abbreviated Day*

$775 Monthly (8:30 a.m. - 3:30 p.m. M-F)

Non-Refundable Fee Schedule:

Wait List Fee - $30 (part of the Admissions Fee)
Admissions Fee - $130
Materials Fee - $150

Tuition Guidelines:

Tuition prices stated above are for summer 2021 only and will increase for school year 2021-2022.
Non-Refundable fee’s, starting tuition and signed Enrollment Contract with ACH form due before child starts the program.
Monthly tuition is due by ACH Debit or Bank Check on or before the first business day of the month.
If families enroll mid-month, a pro-rated tuition charge will be due prior to the start date. Prorates are calculated by first week of enrollment, not by the first day of enrollment.
Mid-month withdrawals are not accepted, full monthly tuition will be assessed.
More tuition guidelines & policies can be found in the Academy Family Handbook (pages 16-20) located on our website: https://academychild.com

Parent/Guardian Signature*

Date*

Parent/Guardian Signature

Date

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Phone

This field is for validation purposes and should be left unchanged.

3-4 Years SUMMER ONLY APPLICATION 2021

Preschool & Pre-Kindergarten (July 1, 2021 – August 20, 2021)

Have Questions?