MSDE 3–4-year-old Part Day Application - 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:

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:*

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

Program Age Group*

Preschool

PreKindergarten

Is your child toilet trained?*

Yes

Almost

Preschool Offerings*

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

MSDE Half-Day Program - $510 Monthly [9:00 a.m.-12:30 p.m. (3.5 hours per day)]

MSDE Part Day Program - $840 Monthly [9:00 a.m.-3:30 p.m. (6.5 hours per day)]

PreKindergarten Offerings*

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

MSDE Part Day Program - $840 Monthly [9:00 a.m.-3:30 p.m. (6.5 hours per day)]

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^st :
1. Will owe the first and last non-refundable tuition installments or
*2. A non-refundable deposit of *$250 (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.
More tuition guidelines & policies can be found in the Academy Family Handbook (pages 16-20) located on our website: www.academychild.com

Non-Refundable Fee Schedule:

Wait List Fee- $30 (part of the Admissions Fee)
Admissions Fee- $130
Materials Fee- $150
Deposit- $250

Parent/Guardian Signature*

Date*

Parent/Guardian Signature

Date

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MSDE 3 – 4-year-old Part Day Application

MSDE Approved - 10 Month Preschool & Pre-K Application
School Year Only Follows the MCPS School Calendar

Have Questions?

MSDE 3 – 4-year-old Part Day Application

MSDE Approved - 10 Month Preschool & Pre-K ApplicationSchool Year Only *Follows the MCPS School Calendar*

Have Questions?

MSDE Approved - 10 Month Preschool & Pre-K Application
School Year Only Follows the MCPS School Calendar