Potomac Nursery SchoolRebecca MancusoRebecca Mancuso202007-11-05T15:16:00Z2007-11-05T15:38:00Z2007-11-05T15:38:00Z111116336Potomac Nursery School5214743311.8134Potomac Nursery School12300 Falls RoadPotomac, Maryland 20854301-340-0579Application for Admission 2008 - 2009Child Information________________________________________ ______________________________Name of Child (first and last)Prefers to be called___________________ _____________ ______________________________ _________________Date of Birth Gender (M/F) Home Phone Subdivision ________________________________________ __________________________ ________________Home Address City/State Zip ____________________________________________________________________________________Describe any medical conditions, allergies, developmental or behavioral issues your child may have._________________________________ __________________________________________________Primary language spoken at home. Names and ages of siblings._________________________________ _____________________ ____________________________Previous school attended. Phone Permission to contact school (y,n) Parent Information________________________________________ ___________________________________________Father/Guardian Mother/Guardian________________________________________ ___________________________________________Home Phone (if different from above) Home Phone (if different from above) ________________________________________ ___________________________________________Cell Phone Cell Phone________________________________________ ___________________________________________Work Phone Work Phone________________________________________ ___________________________________________Occupation/Employer Occupation/Employer Application page 2 (please complete both pages) Schedule of Classes: *please select a class from the list below. Age Class Schedule Tuition___ 2 year olds Tuesday and Thursday from 12:15-2:45 $270.00 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------___ 3 year olds Tuesday and Thursday from 9:00-11:45 $250.00___ 3 year olds Monday, Wednesday and Friday from 9:00 - 11:45 $370.00___ 3 year olds Monday – Friday from 9:00 - ll:45 $580.00___ 3 year olds Full Time Monday – Friday from 8:00 - 4:00 $950.00------------------------------------------------------------------------------------------------------------------------------------------------------------------------___ 3 and 4 year olds Monday, Wednesday, Friday from 12:15 – 3:00 $370.00------------------------------------------------------------------------------------------------------------------------------------------------------------------------___ 4 year olds Monday – Friday from 9:00- 11:45 $580.00___ 4 year olds Full Time (Monday-Friday 8:00-4:00) $950.00 Lunch Bunch:Lunch bunch is available for 3 and 4 year olds. Children who participate in Lunch Bunch can utilize our daycare after 1:00 at $8.00 per hour. Any additional daycare used will be billed to you at the end of the month. ___ Tuesday, Thursday 11:45 - 1:00 $55.00___ Monday, Wednesday, Friday from 11:45- 1:00 $80.00___ Monday – Friday from 11:45 – 1:00 $130.00Registration Deposit and Registration Fee:A Registration fee and deposit are due at the time of enrollment. The Registration deposit is equal to one month’s tuition (the deposit will be returned to you as May’s Tuition). The Registration fee is $15.00. The Registration Fee and Deposit are non refundable.School Policies:The registration fee and deposit must be paid before your child is officially enrolled. The registration fee and deposit are non-refundable.One month’s notice is required for withdrawal from the nursery school. If the Director does not receive a month’s notice, the tuition for the following month will be required.Tuition is due on the first day of each month. There are no reductions in tuition for illness or family vacations.Potomac Nursery School reserves the right to dismiss a child with behavioral or health problems. This action will not be taken until the parents and the teacher have worked together to try to resolve the problem.All required medical forms and immunization forms must be received by Potomac Nursery School before the first day of school. Potomac Nursery School does not practice or condone discrimination based on race, religion, color or national origin in the admission of pupils or the employment of faculty and administrative staff.Potomac Nursery School reserves the right to make or change rules, restrictions and conditions and are consistent with the safety, health and best interests of our students, faculty and families.Potomac Nursery School is accredited and licensed by the Maryland State Department of Education. We encourage parents to visit our classrooms at anytime during the school year (without notice). A security key-code will be given to parents for safe entry into our building.I have carefully read the terms and conditions stated above. I agree to comply with the terms and herein expressed and to be bound by the Potomac Nursery School’s regulations and conditions. Date: ________________________ Signature_________________________________________________________________________Please print child’s name (first, last)________________________________________________________________________________Mailing Address: P.0. Box 2194 Rockville, MD 20852 web: www.potomacnurseryschool.com email: potomacnursery@aol.com