I AGREE TO CONTRACT WITH THE BELMONT NURSERY SCHOOL SERVICES FOR
MY CHILD ______________________________________________________________. THE CONTRACT PERIOD: SEPTEMBER 2019-JUNE 2020 CHILD'S FULL NAME: ____________________________________________________ HOME ADDRESS: ________________________________________________________ CITY, STATE & ZIP: ______________________________________________________ PHONE: (_____)_____________________ BIRTH DATE: ________________________
NAME OF PARENT(S) OR GUARDIAN(S) MOTHER: _______________________________________________________________ BUSINESS ADDRESS: _____________________________________________________ PHONE: (_____)__________________________________________________________
FATHER: ________________________________________________________________ BUSINESS ADDRESS: _____________________________________________________ PHONE: (_____)__________________________________________________________
NUMBER OF DAYS PER WEEK: (Check only one) 2 _____ Circle only 2 days: M T W T F
TIME SESSION DESIRED: (Check only one) _____ A.M. Session 8:00-12:00
I UNDERSTAND THAT I AM PURCHASING TIME BLOCKS WITHIN A GIVEN CONTRACT PERIOD FOR MY CHILD. THEREFORE, WHEN MY CHILD IS NOT IN ATTENDANCE FOR A GIVEN DAY OR SERIES OF DATES, DUE TO ILLNESS, EXTRA CURRICULAR ACTIVITIES, SNOWDAYS, OR PERSONAL VACATIONS, I AGREE TO PAY FOR MY FULL TIME BLOCK AS CONTRACTED. A DEPOSIT OF $100.00 MUST ACCOMPANY THIS APPLICATION. THIS DEPOSIT WILL BE APPLIED TO YOUR LAST MONTH�S TUITION. YOUR DEPOSIT IS NON-REFUNDABLE UNLESS THE CHILD IS REFUSED ADMISSION TO THE PROGRAM OR YOU WITHDRAW THE CHILD WITHIN ONE WEEK AFTER ENTRY INTO THE PROGRAM. Parent's Signature __________________________________ DATE: _________________________
Director's Signature __________________________________ DATE: _________________________ *Special Notes: |