Enrollment Contract

Belmont Nursery School
773 Belmont Street
Belmont, MA  02478
(617) 489-8694

I AGREE TO CONTRACT WITH THE BELMONT NURSERY SCHOOL SERVICES FOR

MY CHILD ______________________________________________________________.

THE CONTRACT PERIOD:  SEPTEMBER 2009-JUNE 2010

CHILDíS 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
3  _____  Circle only 3 days:  M  T  W  T  F
4  _____  Circle only 4 days:  M  T  W  T  F
5  _____  Monday through Friday

 

TIME SESSION DESIRED:  (Check only one)

_____ A.M. Session 8:00-12:00
_____ A.M. & P.M. Session 8:00-3:00
_____ A.M. & P.M. & After School 8:00-5:30
_____ Afternoon Session 12:00-3:00
_____ Afternoon Session & After School 12:00-5:30

 

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 MONTHíS 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.

Parentís Signature

__________________________________  DATE:  _________________________

 

Directorís Signature

__________________________________  DATE:  _________________________

*Special Notes: