calvary learning academy


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CALVARY LEARNING ACADEMY

PRESCHOOL 2016-2017 School Year Registration Form *A non-refundable registration fee of $100 ($75 for each additional child) must accompany this form to reserve your child’s preschool placement. CLASS SCHEDULE Class name Jr. Pre-K

Days/Time

Tuition

Age 3 by August 1, 2016 $95/month/ M/W 9:00 am –11:30 am 10 months M/W 12:30 pm – 3:00 pm T/TH 9:00 am – 11:30 am T/TH 12:30 pm – 3:00 pm *Children must be toilet trained to attend Preschool

3’s Plus

Age 4 by February 1, 2017 M/W/F 9:00 am – 11:30 am M/W/F 12:30 pm – 3:00 pm

$135/month/ 10 months

Pre-K

Age 4 by August 1, 2016 M/W/F 9:00 am – 11:30 am M/W/F 12:30 pm – 3:00 pm T/TH 9:00 am – 1:00 pm

$135/month/ 10 months

Kinderskills

Age 5 by February 1, 2017 M/W/F 9:00 am – 1:00 pm M/T/W/TH/F 9:00 am – 11:30 am M/T/W/TH/F 12:30 pm – 3:00 pm T/TH 9:00am – 3:00pm

$190/month/ 10 months

Please return completed form and registration fee to Calvary Learning Academy, 575 W. Northfield Dr., Brownsburg, IN 46112. You will then receive a registration confirmation letter. The school year is scheduled to begin the week of Aug. 8, 2016. For additional information or questions, please contact Lori Wilcoxson, Director, at 852-2594 or [email protected].

PRESCHOOL APPLICATION FOR ENROLLMENT Class Name: (i.e. Jr. Pre-K, Pre-K) ___________________________________________________________ Days/Time: 1st choice_________________ 2nd choice_________________3rd choice____________________ Child’s Full Name:_________________________________________________________________________ Name to be used in class: ___________________________________________________________________ Age by Aug. 1, 2016: _________________ Date of Birth: ___________________ Sex: M _______ F _______ Home Address: ____________________________________________________________________________ Street

City

State

Zip

Parent’s email address_______________________________________________________________________ Home Phone: ________________Mom’s Cell:____________________ Dad’s Cell:______________________ Father’s Name: ________________________________________ Work Phone: _________________________ Employer: _________________________________Occupation: _____________________________________ Mother’s Name: _______________________________________ Work Phone: _________________________ Employer: _________________________________Occupation: _____________________________________ Emergency contact person: ________________________________________ Phone: ____________________ Parent’s marital status: _______________________Child living with: ________________________________ Church affiliation:__________________________________________________________________________ (Please include the name of your family’s church home if you have one) Does your child have any special needs or allergies? _______________________________________________ Calvary Learning Academy has permission to use my child’s picture on their website, Facebook or brochures. (No names will be used to identify the child) Yes_____ No _____ Calvary Learning Academy has permission to include my child’s name, my name, email address and phone number to be included in a class list for parents to facilitate planning play dates, parties and carpools. This list will only be distributed to your child’s class. Yes____ No_____ Parent Signature______________________________________________________ Date__________________ ***************************************Office use only************************************** Class assignment_________________________________ Lottery #_______________ R$________Ck #_________ C_______ M________ D______ OH_______ PLEASE FILL OUT FINANCIAL DEBIT FORM TO COMPLETE REGISTRATION

Tuition Payments Made Easy Calvary Learning Academy REQUIRES automatic tuition payments. The process is very simple and will not only have you writing one less check each month, it will also eliminate the possibility of a late tuition payment. To begin, simply fill out the Automatic Debit Authorization Form, attach a voided check and turn it in with your registration packet. We cannot accept a deposit slip from your savings account, so if you do not have a checking account, please get a letter from your bank authorizing this monthly withdrawl from savings. Each month on the 5th, your tuition payment will automatically transfer from your preferred banking account into Calvary’s bank account. If you do not have sufficient funds in your account to cover the withdrawl, you will receive notice of non-sufficient funds and be required to pay the tuition in cash along with a $20 penalty. The first transfer will occur on August 5, 2016 and the last transfer will occur on May 5, 2017. You may make changes to this form any time by stopping in the office.

CALVARY LEARNING ACADEMY AUTHORIZATION FOR DIRECT TUITION PAYMENT I authorize Calvary Learning Academy and First Merchants Bank to initiate debits from my (check one) _____Checking _____Savings account. This authority will remain in effect August 5, 2016 through May 5, 2017. I can stop payment of any entry by notifying my financial institution and Calvary Learning Academy 3 days before my account is charged. I understand that debits will only be processed on the 5th of each month. A voided check must be attached to this form. Printed Name:_______________________________ Signature:__________________________________ Today’s Date:_______________________________ My Bank’s Name is:___________________________ My Bank’s Routing Transit # is:__________________ (The routing number is the first 9 numbers at bottom left of your check) My Account Number is:________________________ Date to Start Debiting My Account:_______________

Each account debit will be the following amounts:

Tuition payment is not subject to adjustments due to illness, vacation, absences or weather closings. Yearly tuition is divided into 10 equal payments.

Tuition (Child’s Name)_______________________ $ __________

If you have any questions or concerns about Automatic Tuition Payments, please contact Shellody Brenton, bookkeeper, at Calvary’s office 317-852-2541.

Total Debit Each Month

Tuition (Child’s Name)_______________________ $ __________ Tuition (Child’s Name)_______________________ $ __________

$ __________

(Please attach a voided check or letter from your bank)