Registration for New Students/Siblings

Child’s Name: ______________________________________________________ D.O.B._____________________ Sex: F r M r

                                First                                     Last                          Middle

Child’s Address: ____________________________________________________________________________________________

                                  Street                                              City                                               State                                   Zip

Mother/Guardian Name: ___________________________________________________ Home Phone: ___________________

Address: ___________________________________________________________________Cell Phone:______________________                   Street                                 City                                   State                 Zip

Employed By:______________________________________________________________ Phone: _________________________

Father/Guardian Name:____________________________________________________ Home Phone: ___________________

Address: ___________________________________________________________________Cell Phone: ____________________

                  Street                                  City                                   State                 Zip

Employed By:______________________________________________________________ Phone:_________________________

Emergency Contact (other than Parent):

Name:_____________________________________Relation:_______________________ Home Phone:___________________

Address: ___________________________________________________________________Cell Phone:_____________________

                  Street                                 City                                  State                  Zip

Please Check Appropriate Boxes: (Extended Hours: Any part of 7:00-8:45)

r Half M-F (8:45-12:30)               r Half M-W-F (8:45-12:30)            r Half T-TH (8:45-12:30)

r Full M-F (7:00-8:45) 4:00    r Full M-W-F (7:00-8:45) 4:00   r Full T-TH (7:00-8:45) 4:00

r Full M-F (7:00-8:45) 5:00    r Full M-W-F (7:00-8:45) 5:00   r Full T-TH (7:00-8:45) 5:00

I agree to:

  • *A non-refundable $50 registration fee with this application for new students, returning students and siblings.
  • No credit will be given for absences due to illness and tuition must continue to be paid.
  • Tuition is not charged for 3 weeks throughout the school year. These vacations are Christmas, February vacation and April vacation.
  • Tuition is due one week in advance throughout the year payable on Thursdays or Fridays for the following week. You may elect to pay weekly, bi-weekly or monthly.
  • We are open when Lowell Public schools are open. If school is cancelled because of weather, it will be announced on WCAP (980) and Boston TV stations. We do not have delayed openings.
  • In case of withdrawal of my child from the center, I agree to give the center a two-week notice prior to withdrawal. A new enrollment fee and deposit will be required should the child re-enroll at a later date.

Parent Signature:__________________________________________________ Date:____________________________________

PLEASE RETURN BY January 29, 2010                                                           Date Received: __________________________