ENROLLMENT APPLICATION - SCHOOL AGE Child's 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 $Part Time 5 days Weekly $Part Time 5 daysPart Time 3 days a week* Monthly $Part Time 3 days Weekly $Part Time 3 daysPart Time 2 days a week* Monthly $Part Time 2 days Weekly $Part Time 2 days Monday TuesdayWednesdayThursday FridayBreakfastLunch Snack 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 Father's Name Social Security #Father DL #Father AddressFather CityFather StateFather ZipFather EmailFather Home PhoneFather Place of EmploymentFather Cell PhoneFather Job TitleFather Work PhoneFather Custody Information Marital Status 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 LocationKids Adventure Learning CenterENROLLMENT AGREEMENT & CONSENT TO MEDICAL TREATMENT OF MINOR INFANT/PRESCHOOL) I/We the undersigned parents/legal guardian(s) ofdo hereby agree to abide by the following terms and conditionsFinancial Terms : 01. Pay tuition at a weekly rate of 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'of the 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 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 child19. 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 ofthe 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 PARENT OR LEGAL GUARDIAN SIGNATUREClear AUTHORIZED REPRESENTATIVE OF KIDS ADVENTURE ClearCurrent Tuition Terms :I understand that my tuition fees are as follows : Tuition TermsWeekly or Monthly Discount Type I Amount $Classroom Total Tuition $Tuition 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. Time scheduleInOutMondayTuesdayWednesdayThursdayFridayKIDS ADVENTURE LEARNING CENTER1834 W. Valencia Dr.Fullerton, CA 92833Phone: 714-525-7377Fax: 714-525-3985Kids Adventure learning 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 wel9ome to sign up. This program is for PARENTS/GUARDIANS ONLY.Please be aware this is a one way form of communication, no responses to Remindmessages will be received by Kids Adventure Leaming. Please always call the center directlyor 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 # Email2Submit
