ENROLLMENT APPLICATION - PRESCHOOL Childs' Name Date of Birth Age GenderMaleFemale Has your child been to a Preschool before? If Yes, Where and for How long?Please check the appropriate program Schedule & Meal PatternFull Time 5 days a week Monthly $Full Time 5 days Weekly $Full Time 5 daysPart Time 3 days a week* Monthly $Full Time 3 days Weekly $Full Time 3 daysPart Time 2 days a week* Monthly $Full Time 2 days Weekly $Full Time 2 days MondayTuesdayWednesdayThursdayFridayBreakfastLunchSnack Hours of CareHours of Care (ex 9-5) Request starting date How did you hear about usPARENT / GUARDIAN INFORMATIONMother's Information Mother's Name Social Security # DL # Address City State Zip Email Home Phone Place of Employment Cell Phone Job Title Work PhoneFather's Information Fathers's Name Social Security #Father DL # Father Address Father City Father State Father Zip Father Email Father Home Phone Father Place of Employment Father Cell Phone Father Job Title Father Work Phone Father Custody Information Marital StatusSelect valueSingleMarried List any allergies your child has My child excels in My child needs help in Parent's evaluation of child's personality Does your child have any special needs/problems/fears? Additional information we should know about your childReturn this completed application with your enrollment fees as soon as possible to reserve your child's space. Enrollment fees do not include your first week's tuitionI understand I am signing up for specific days and times and I am responsible for Payment according to the school policyI understand that the enrollment fees are non-refundable. Date Parent/Guardian's SignatureClear*Varies by Pre-School LocationACADEMY ON THE HILLS ENROLLMENT AGREEMENT & CONSENT TO MEDICAL TREATMENT OF MINOR (INFANT/PRESCHOOL) I/We the undersigned parents/legal guardian(s) ofdo hereby agree to abide by the followingterms and conditionsFinancial Terms : 01. Pay tuition at a weekly rate of(1) Monthly rate of02. Prepay all tuition due on a weekly basis (tuition becomes due on Monday of each week and becomes delinquent by the third day of the week).03. Pay a $25.00 charge on all checks returned due to insufficient funds.04. Pay a non-refundable annual registration fee as specified in the tuition fee schedule on an annual basis.05. Give two (2) weeks written notice in writing regarding the termination of enrollment of my/ our child/ children. Failure to give such notice shall result in a charge of two week's tuition in lieu.06. Agree to pay a late fee of $2.00 for each minute (per child) delay in picking up my child/children after 6:00 pm.07. Agree to be responsible for the payment of tuition on time without arrears. Failure to do so will subject my child to be removed from the school.08. Agree that any absences (vacation, sick, etc.) will not allow a reduction in tuition.09. Your child/children will receive two weeks of 50 % tuition per calendar year. Any additional days the child is absent, regular fees are due in full latest by the Tuesday of the current week.10. Tuition is due by 3rd business day'ofthe month (monthly pay) or Tuesday of the current week (weekly pay). If tuition is not received by these days a $ 25 dollar late fee could be assessed.11. Accounts two weeks in arrears may result in disenrollment; however, upon payment, enrollment may be reinstated at discretion of management with applicable paid tuition and registration fee. Accounts in arrears may be referred to a collection agency and I will be responsible for the balance of my account.Policies and Procedures:12. Agree to escort my child / children to the school by me / us or by another designated adult authorized by me / us. The child / children shall be handed over to the Director or any other designated person from the facility.13. Agree to sign in with my full name when the child is brought into the facility and sign out when the child is picked up from the school on the sign in and out sheets provided. Failure to do so will be in violation of Section 1596:81 of the Health and Safety Code.14. The facility observes 10 public holidays for the year. I/We agree to pay regular fees that will include these holidays (Fees will not be prorated for holidays). 15. I/ We, the undersigned parents of legal guardians ofdo hereby authorize Academy on the hills to act as the agent for undersigned to consent any transportation, x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the general or special supervision of any physician or surgeon licensed under the provisions of Medical Practice Act in the State of California whether such diagnosis or treatment is rendered at the office of the said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, hospital care or transportation being required.16. It is further understood that this authorization is given to provide authority and power on the part of the afore - mentioned agent to give specific consent to any and all such transportation, diagnosis, treatment or hospital care which the afore-mentioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of the California Civil Code and shall remain in effect until termination from the school, unless sooner revoked in writing delivered to the said agent. It is further understood that Academy on the hills will exercise medical authorization only if :• The child's condition is such that medical care is urgently needed in the opinion of Academy on the hills.• The parent/guardian or other designated agent normally empowered to authorize medical care cannot be reached. 17. It is understood that as the parent(s) or legal guardian(s) of I/We the undersigned do hereby agree to be solely and completely responsible for any and all medical treatment costs and transportation costs related thereto, rendered on behalf of the said child, pursuant to the AUTHORIZATION AND CONSENT TO MEDICAL TREATMENT OF MINOR. If any action or proceeding be brought to enforce any part of this agreement by any party, the prevailing party shall be entitled to recover, in addition to other relief, reasonable attorney fees and costs.18. Pursuant to Title 22 of the California Administrative Code, the parent is to be made aware that the Department of Social Services or agencies authorized by State or Federal Laws, whichever apply, have the right to interview the child, school staff and to inspect and audit all records maintained by the school without prior consent. The parent is also to be made aware to the department's right to observe the physical conditions of the child including conditions indicating abuse and neglect and to have a licensed medical professional examine the child 19. A child may be terminated from the school if, in opinion of the Director of the school, it is deemed to be in the best interest of the school or the child.20. Biting Policy: 1st Incident - Instruct teachers to be more vigilant, supervise more closely. 2nd incident - Parent conference with teacher, Director / Administrator. 3rd incident - Parent conference with Teacher, Director / Administrator and the child will be in observation for one (1) week. Parents will be asked to give in writing what remedial actions are taken or will be taken in the future. 4th incident - if improvement has not occurred since previous bites (time-wise and behavioral pattern) at the recommendation of the teacher and the discretion of Director/ Administrator to issue termination. Termination could be immediate at the discretion of the Director/ Administrator as referred in Section 16.21. The terms of this agreement including fees are subject to change with 30 days' notice22. I as the parent or guardian, consent for my child's picture to be part of any school material including school's website, social media and other promotional websites. The pictures will only be used by the school for educational or promotional purposes.I (We) acknowledge receiving copies of the ENROLLMENT AGREEMENT/AUTHORIZATION AND CONSENT TO MEDICAL TREATMENT OF MINOR, THE DISCIPLINE PLAN CONTRACT, PERSONAL RIGHTS AND PARENT'S RIGHTS. I (We) further acknowledge having read, understood and fully agree to be bound by the terms and conditions of this agreement. Dated AUTHORIZED REPRESENTATIVE OF ACADEMY ON THE HILLSClear PARENT OR LEGAL GUARDIAN SIGNATURE ClearI (We) acknowledge receiving copies of the ENROLLMENT AGREEMENT/AUTHORIZATION AND CONSENT TO MEDICAL TREATMENT OF MINOR, THE DISCIPLINE PLAN CONTRACT, PERSONAL RIGHTS AND PARENT'S RIGHTS. I (We) further acknowledge having read, understood and fully agree to be bound by the terms and conditions of this agreement. Weekly or Monthly Discount Type / AmountClassroom Total Tuition Schedual AttendanceTuition fees are based on the following scheduled attendance. I understand I will be charged additional tuition if my child's attendance increases beyond their regularly scheduled attendance. This includes late pick up for part time schedule if child is picked up after 12pm. InOutMondayTuesdayWednesday Thursday Friday Academy on the HillsPreschool Toilet Training Plan Childs Name: Birth Date: Todays Date:Toileting Plan 1. How many wet diapers a day approx.: 2. How often does your child have a bowel movement: 3. Any special comments or concerns in reference to diapering/toileting: 4. Method preferred for toilet training: 5. Specific equipment used and time line of use as directed/provided by parent as well as a timeline of introduction of appropriate clothing:All parents are asked to please provide diapers and wipes for their child, as well as any ointments, powders, etc. that may be preferred by the parent. Please make sure all supplies are clearly labeled with your child's name.I have discussed my infant's needs and services plan with the center's Director and agree with the information provided here. I will notify the Director immediately of any changes in the needs of my child. Parents Name Date(Toilet planing) Center Representative: Daytime Phone# : DateToilet planing 2 Signature (Toilet planing)ClearAcademy on the Hills10 MarebluAliso Viejo, CA 92656Phone: 949-360-7022Fax: 949-360-7122Academy on the Hills uses Remind, a text messaging/email service, to send out important reminders and/or safety alerts if ever needed. If you would like to be signed up for Remind text messages/emails please provide your name and preferred cell phone number and or email below. One or both Parents are welcome to sign up. This program is for PARENTS/GUARDIANS ONLY.Please be aware this is a one way form of communication, no responses to Remind messages will be received by Academy on the Hills. Please always call the center directly or stop by the office if you have any questions or concerns. Child's Name: Classroom: Contact 1 Contact 1 Name Contact 1 Cell Phone # Email1Contact 2 Contact 2 Name Contact 2 Cell Phone # Email2PreSchool Supply ListParents please make sure to supply your child's teacher with the following supplies. If your child is running low on a specific item they will notify you verbally or by sending home a note.1 standard crib sheet & thin blanket in a clear bag- to be sent home on Fridays for laundering. Need to be brought back at the beginning of the week. Please put name on sheets. At least 2 pairs of extra clothes in a clear bag with name on clothes. Pencil box with name (Crayons, markers pencils, Elmer's glue)POTTY TRAINING: Sleeve of diapers/pull ups with name on bag and wipes. OPTIONAL:Water bottle/sippy cup with name and current datePlease remember any item brought the classroom MUST be labeled with your child's name. Thank you!Please remember any item brought into the infant/toddler classroom MUST be labeled with your child's name. Any food or bottle item should be labeled with the child's name as well as the date it was brought in; your child's teacher can assist you with this.SubmitReset
