Goshen Christian Montessori School

GOSHEN CHRISTIAN MONTESSORI SCHOOL, LLC 312 ½ S. 5th St. Goshen, IN 46528 [email protected] (574) 596-0782

Enrollment Form Student Information

Student’s Full Name Preferred Name

Address City State Zip

Birthday Age as of Sept.6, 2015 Is the student potty trained? Y/N/Practicing Name(s) of previous daycare/schools attended______Who is the primary daytime care provider? ______Where did you hear about Goshen Christian Montessori School? ______

Our class runs 9-11:45am 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 and delays (we start school at 10:00am on 2 hour delay days and are closed when GCS are closed). Our school year runs Sept. 6, 2015-May 26, 2016.

Mon. and Fri. classes, as well as before and after school care may be available based on demand. If you would like additional care times for your child, please list those needs below. School Director will confirm availability by July 25th. ______

Responsible Parties

Father’s Full Name Mother’s Full Name

Address Address

City State Zip City State Zip

Employer/Occupation Employer/Occupation

Home Phone/Cell Phone Home Phone/Cell Phone

Work Phone Work Phone

Email Address Email Address Enrollment Understanding I (we) understand that, upon 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 after registration will incur a $100 closing fee. Accounts withdrawing from class during the school year will incur a $145 closing fee. Tuition may be paid in full or may be divided into nine monthly payments that are due by the first of each month, beginning September 1st, 2015, with a final payment due May, 1st 2016. A $35.00 NSF charge will be applied to all bounced checks. Tuition received after the 1st day of each month is late with a $20.00 fee applied. Accounts that are 30 days past due will not be allowed to send their students to GCMS until payment is made. Accounts 60 days past due will be sent to a collection service. Families of students who are picked up from school after 11:50 will incur a $2.00 per minute late fee. Families of students who are picked up after our closing time of 12:00pm will incur a $10 fee for the first minute and a $2.00 per minute late fee after the first minute. 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 $145 per month, or $1239.75 (due by Sept. 1, 2015) for the whole year for one student. For families with two siblings enrolled, tuition is $275.50 monthly or $2355.53 (due by Sept. 1, 2015) for the whole year. The following is due no later than Sept 1st, 2015:  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, and a signed Emergency Contact form  The first month's tuition or tuition for the whole year, depending on your payment preference  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 fill in the appropriate tuition amount and the responsible paying party’s signature) I will be responsible to pay ______monthly tuition payment to Goshen Christian Montessori by the 1st of each month, from Sept 2015 through May 2016, or I will pay the entire year’s tuition of ______by Sept 1, 2015.

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______

Please list your child’s doctor and phone number here:______If there are any alternate numbers please list them here:______

If your child has any allergies or other 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 ______

Parent’s Signature and date:______