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St. John Early Childhood Center 2018-19 New Enrollment Form Instructions: Please print legibly. Student Data Student Last Name:
First Name:
Address:
City:
Date of Birth: Race:
Middle:
Gender:
Asian
Black
White
State:
Zip:
Public School District: Hispanic
American Indian
Other: _____________________
Contact Information Mother’s Name:
Residing in same home as student?
Home Phone:
Preferred Day Phone:
Yes
No
Yes
No
Email Address: Place of Employment:
Occupation:
Father’s Name:
Residing in same home as student?
Home Phone:
Preferred Day Phone:
Email Address: Place of Employment:
Occupation:
Emergency Contacts – To be contacted if parents are not available Name:
Relationship:
Phone:
Name:
Relationship:
Phone:
Releases Yes
No
VIDEOS/TV - I give permission for my child to be included (individually or in a group) in video footage: church videos, school videos or television coverage (PR or advertising opportunities).
Yes
No
INTERVIEWS - I give permission for my child to be interviewed for video coverage, church videos, school videos or television.
Yes
No
PHOTOGRAPHS - I give permission for my child to be included in photographs for school or church materials (brochures, posters, ads, publicity, etc.).
Yes
No
Yes
No
INTERNET/WEBSITE - I give permission for my child to be featured in photographs and/or videos to be used on the school website, church website or school associated blogs. SCHOOL FAMILY DIRECTORY - I give permission for my family information to be published in the directory. This will include student name, parents name, address, phone numbers and email.
For Office Use Only Enrollment Fee Date Paid:
Amount:
Check number:
Credit card:
CC Registration Date Paid:
Amount:
Check number:
Credit Card: Continued on Page 2
Student:
Date of Birth:
Page 2
Early Childhood Class Offerings & School Year Tuition – Select one for the student 2 Year Old: 3 Year Old: 4 Year Old: Jr. Kindergarten:
Half Day Full Day Half Day
2 Day: Mon/Wed $1,860 2 Day: Mon/Wed $3,220 2 Day: Tues/Thurs $1,860
3 Day: Mon/Wed/Fri $2,650 3 Day: Mon/Wed/Fri $4,760 3 Day: Mon/Wed/Fri $2,650
Full Day
3 Day: Mon/Wed/Fri $4,470
5 Day: Mon-Fri $7,150
Half Day
3 Day: Mon/Wed/Fri $2,650
Full Day
3 Day: Mon/Wed/Fri $4,470
5 Day: Mon-Fri $7,150
Full Day
4 Day: Mon-Thurs $5,940
5 Day: Mon-Fri $7,150
5 Day: Mon-Fri $7,680
Responsible Party for Financial Obligations Last Name:
First Name:
Address:
City:
E-mail:
Payment Plans
State:
Zip:
Phone: St. John School has partnered with the FACTS Tuition Management to facilitate all payment plans: Pay in full (August 1st) Two payments (August 1st and January 1st) with $10 per payment administrative fee Ten monthly payments (August – May) on the 5th, 20th or 25th with $5 per month administrative fee Payments are securely setup online and made via pre-authorized deductions from a checking/savings account or to a credit card with a fee. After the student enrollment has been finalized, the responsible party for financial obligations listed above will receive an e-mail invitation from FACTS to select the payment plan for 2018/19 school year. Questions regarding payment plans or tuition assistance, contact Sherry Blanner at 636.779.2316 or
[email protected].
By signing below, I acknowledge: Registration of this child at St. John School for the 2018/19 academic year. I understand the non-refundable, annual Enrollment Fee of $150 (reduced to $100 with payment on or before February 16, 2018) is due upon submission of this form and will not apply to the total tuition cost. I understand a student must be officially registered including payment of the enrollment fee before applying for tuition assistance. I have read and will publically support the beliefs and teachings of St. John School as outlined in the School Handbook and will strive to maintain the Christ-centered unity of our community.
_________________________________Date__________ Signature of Parent/Guardian
_____________________________Date__________ Signature of Parent/Guardian
__________________________________________________________________________________________________ Centered Care Offerings & Rates – OPTIONAL REGISTRATION For your convenience you may register for before and after school care on this form. Select the program that suits your needs. Rates are listed for the full school year. Centered Care will be paid through FACTS on the payment plan selected for school tuition. You may choose to complete this registration at a later date on a separate form. Enrollment for Centered Care must be completed by July 13 in order to guarantee a spot.
Drop Off Day(s):
M
T
7:00am Drop Off:
1 Day $220
Pick Up Day(s):
M
4:30pm Pickup:
1 Day $330
5:00pm Pickup:
W
TH
F 3 Day $430
4 Day $550
5 Day $650
2 Day $480
3 Day $650
4 Day $810
5 Day $980
1 Day $430
2 Day $650
3 Day $870
4 Day $1,080
5 Day $1,300
6:00pm Pickup:
1 Day $600
2 Day $920
3 Day $1,250
4 Day $1,570
5 Day $1,900
7:00am Drop Off & 6:00pm Pickup:
1 Day $700
2 Day $1,130
3 Day $1,570
4 Day $2,000
5 Day $2,430
T
2 Day $330 W
TH
F
Intermittent Use: Enrolling student for a day’s use with 48 hour notice ($12 for 7:00am Drop Off, $24 for 6:00pm Pickup) Notice of the billing amount will occur in the following month through FACTS incidental billing. I understand an additional non-refundable fee is required with Centered Care registration of $80 (reduced to $50 with registration by July 13, 2018). Applications received after July 13 for the 2018-19 school year will be ON HOLD until we can re-evaluate our openings.
_________________________________Date__________
_____________________________Date__________
Signature of Parent/Guardian
Signature of Parent/Guardian
