Kinderheart Montessori Preschool Corp

  #21-19490 Fraser Way, Pitt Meadows, BC V3Y 0B6 Phone: 604-460-8558 Montessori Preschool Email: [email protected]

KinderHeart Montessori Daycare Registration Form Office use only (Start date: ______End date______)

Name of Child______Name preferred______

Date of Birth ______/______/______Male / Female (please circle) (dd) (mm) (yyyy)

Preferred Starting Date: Month______Year______

Age at starting date:_ Years______Months______

Home Address: ______

______

Home Phone______Email______

Primary Care Giver’s Name: ______

Day Phone______Cell______Preferred# to call during day______

Place of Employment: ______

2nd Guardian’s Name: ______

Day Phone______Cell______Preferred# to call during day______

Place of Employment: ______

Language spoken in home ______Language concerns______

If yes, please explain______

Previous preschool/daycare experience Yes/No (please circle)(Answer A&B if answered yes)

(A) If yes, where and how long______

(B) Why are you transferring to KinderHeart______

______Daycare (please check daycare program required)

2-day Program (7:30-5:30pm) ______drop - off time ______pick - up time ______

Pricing for 2, 3, 4 and 5 daycare programs

2-day program $495.00 / month 3-day program: $595.00 / month 4 day program: $650.00 / month 5-day program: $750.00 / month (Children under 36 months – full-time fee: $850.00 / month except I/T Care).

Other If your child will not be in KinderHeart’s 2, 3, 4 or 5-day programs, please specify below the care required (part-time spots may not always be available):

______

Price / Month as agreed upon between parent(s) and KinderHeart: ______

Drop In Daycare Rates Half day - $40.00 (up to 4 hours) Full day - $60.00 (4 or more hours)

How did you hear about KinderHeart Montessori? Local paper: _____Friend _____ Flyer: _____Internet _____Web site_____ other: ______I am enclosing a non-refundable $75.00 registration fee ($25 for returning children) with this application form. I understand that the tuition is refundable upon one month’s written notice of withdrawal up to March 1st and that there will be no refunds issued for any portion of the tuition after March 1st. It is also my understanding that the school reserves the right to accept or refuse any application and that the registration fee will be refunded if the school is unable to provide my child with a space.

Signature: ______

Printed Name: ______Date: ______