OF WESTON 2550 Glades Circle, Weston, FL 33327 PRE-KINDERGARTEN APPLICATION 2015-2016 TODAY’S DATE:__________________ DATE TO START SCHOOL:__________________ CHILD’S NAME:________________________________ DATE OF BIRTH:__________________ PARENT’S NAME(S):____________________________________________________________ ADDRESS:____________________________________________________________________ TELEPHONE NUMBER:______________________E-MAIL:______________________________ School year begins August 24, 2015 and ends June 9, 2016. (dates subject to change based on County schedule) Winter Break, Spring Break and Summer Camp are separate programs not included in the school year fees. Full School year tuition can be paid in full at the start of the school year and a discount will be applied. School year tuition can be paid divided into payments based on start dates, payable on the 2nd day of each month, following the initial first payment. Details are provided in the Payment Agreement. There is an annual, non-refundable, non-transferable registration fee; $220.00 for the Pre-Kindergarten Program Check your choice of program (s) below Pre-Kindergarten 4 years old by Sept 1, 2015 ___Cambridge Schools Program ___Cambridge Schools Program Bilingual ___Pre-K full day without VPK Certificate Program Hours (8:30 – 12:00) (8:30 – 12:00) (8:30 – 3:00) ___VPK 3-Hour Program 2015-2016 SCHOOL YEAR (12:00 – 3:00) BEFORE AND AFTER SCHOOL PROGRAMS ___ Before School Monday – Friday ___ After School Monday – Friday (7:00 - 8:30) (3:00 – 6:00) I agree to enroll my child in the program(s) checked above _______________________________ Parent Signature OF WESTON PRE-SCHOOL APPLICATION 2015-2016 TODAY’S DATE:__________________ DATE TO START SCHOOL:__________________ CHILD’S NAME:________________________________ DATE OF BIRTH:__________________ PARENT’S NAME(S):____________________________________________________________ ADDRESS:____________________________________________________________________ TELEPHONE NUMBER:__________________E-MAIL:__________________________________ School year begins August 24, 2015 and ends June 9, 2016. (dates subject to change based on County schedule) Winter Break, Spring Break and Summer Camp are separate programs not included in the school year fees. Full School year tuition can be paid in full at the start of the school year and a discount will be applied. School year tuition can be paid divided into payments based on start dates, payable on the 2nd day of each month, following the initial first payment. Details are provided in the Payment Agreement. There is an annual, non-refundable, non transferable registration fee; $120.00 for the Toddler, Two and Three year old Programs. TODDLERS 18 Months by Sept 1, 2015 ____Monday – Friday ____Monday-Friday Program Hours (8:30 – 3:00) (8:30 – 12:00) TWOS 2 years old by Sept 1, 2015 ____Monday – Friday ____Monday – Friday BILINGUAL ____Monday – Friday Program Hours (8:30 – 3:00) (8:30 – 3:00) (8:30 – 12:00) THREES 3 years old by Sept 1, 2015 ____Monday – Friday ____Monday – Friday BILINGUAL ____Monday – Friday Program Hours (8:30 – 3:00) (8:30 – 3:00) (8:30 – 12:30) *Program offerings are subject to change based on enrollment. BEFORE AND AFTER SCHOOL PROGRAMS Before School – 7:00 a.m. – 8:30 a.m. ___ Monday – Friday After School – 3:00 p.m. – 6:00 p.m. ____Monday – Friday I agree to enroll my child in the program(s) checked above______________________________ Parent Signature Board of County Commissioners, Broward County, Florida HUMAN SERVICES DEPARTMENT Community Partnerships Division Child Care Licensing and Enforcement Section 1 CHILD ENROLLMENT INFORMATION PASSWORD Name of Child: First Date of Attendance: Address: Sex: Birth Date: Preferred Name: List of Known Allergies: Special Needs: Mother Name: E-mail: Home Address: Phone: Place of Employment Name: Phone: Address: Email: Father Name: E-mail: Home Address: Phone: Place of Employment Name: Phone: Address: Email: Guardian Name: E-mail: Home Address: Phone: Place of Employment Name: Phone: Address: Email: Child’s Physician Office Name: Email: Address: Phone: May facility consult the above physician if parent/guardian cannot be reached? 1 Yes ☐ No ☐ Revised 11/1/2014 Other persons to be notified in case of illness or accident Name: E-mail: Home Address: Phone: Name: E-mail: Home Address: Phone: Name: E-mail: Home Address: Person(s) permitted to remove child: Phone: Mother Yes ☐ No ☐ Father Name: Address: Relationship: Phone: Name: Address: Relationship: Phone: Name: Address: Relationship: Phone: Name of Person Enrolling Child (Print) Yes ☐ No ☐ Signature of Person Enrolling Child Date of Enrollment 2 Revised 11/1/2014 Cambridge Schools 2015-2016 Parent/Guardian Payment and Policy Agreement and Consent Child Name:__________________________________________________________________________ Primary Parent/Legal Guardian Name:______________________________________________________ Other Parent/Legal Guardian Name:________________________________________________________ Home Address:________________________________________________________________________ Home Phone:_______________Cell phone #1___________________ Cell phone #2_________________ I/we,____________________________________parent(s) or guardian(s) of _____________________________ do hereby enroll my/our child in the Cambridge School. This payment and policy agreement and consent form will remain in effect for any time my/our child is enrolled during Summer Camp 2015, School Year 2015-2016 and/or Summer Camp 2016. ____Registration Initial I/We agree to pay Cambridge Schools the non-refundable, non-transferable registration fee of $120.00 for enrollment in the toddler through the 3 year old program or $220.00 for enrollment in the Pre-Kindergarten program. This is an annual registration fee and is due at the time of registration. Any circumstances that may lead to reenrolling a child during the same school year will require a new registration form and full registration fee. ____Tuition Initial I/We understand that I/we are enrolling our child in an ongoing school year program and tuition fees are payable either in full. prior to the 1st day of school or can be paid in scheduled payments by the first day of attendance and following with payments due on the 2nd of each month. Winter, Spring and Summer Camps are separate programs that require separate registrations and fees. The school year payments remain the same for the months that Winter, Spring and Summer Camps occur. There is no proration of school year tuition during those months, as the tuition fee is part of the full school year program. I/We have received, read and understand the Tuition Fee Schedule. Payment can be made by check, credit card, debit card, cashier’s check or money order. American Express is not accepted. When paying by check, please note your child’s name in the memo section. If I/we are enrolling our child in only the Summer Camp program, Winter Break or Spring Break camps, I/we agree to follow the payment requirements and due dates described in the camp registration forms. No refunds or credits are given for any absences due to illness, family vacations, moving or any other interruptions in attendance. ____Discounts Initial Multiple Child Discount: If two or more siblings attend full time (8:30 – 3:00), the child with the greater tuition will pay the full amount and a 10% discount will be applied to the lesser tuition of the siblings (not applicable to Summer Camp, Winter Break, Spring Break or registration fees). School Year Paid in Full: If the entire school year tuition is paid in full by the first day of the school year calendar in August, a 2% discount will be given if payment is made by check or credit card. Camp Cambridge Discount: If all weeks of the entire summer camp program are reserved for full time and paid for in full prior to the first day of camp, a 10% discount will be applied to the tuition fee. Discounts do not apply to fees for before school, after school, before camp, after camp, Winter Break, Spring Break, or any fees other than preschool or summer camp tuition. Payment and Policy Agreement and Consent Page 1 ___Camp Cambridge® Initial Cambridge Schools are closed during County Winter and Spring Breaks. Camp Cambridge is a separate program offered to preschool and elementary school children during these breaks. Reservation must be made in advance to attend any of these days. There is a $45.00 per day charge for each child to attend these programs The hours are 8:30 a.m. to 3:00 p.m. Before and after camp hours will be available for an additional fee. ___Other Fees Initial a) Uniforms - I/We acknowledge that Cambridge Schools have a uniform policy. Children must wear a Cambridge shirt or dress of their choice each day available for sale in our on-site school store. The only exceptions will be on special dress up days for which parents will be notified in advance, such as Friday color days, photo days and Halloween. b) Lunches – Lunch may be brought from home or preordered from our catered lunch service at a cost of $4.00 per day. Lunch must be ordered and paid for at least by Wednesday in advance of the week needed. There are no refunds given for absences or cancellations after this time. ___Penalty Fees Initial I/We acknowledge that the following penalties shall apply for late payment, late pick up and/or returned checks. a) $25.00 late payment – any payment made after the 9:00 a.m. on the third business day following the due date of the tuition payment. b) $3.00 per minute late pick up after scheduled enrollment hours or closing hours of the school if enrolled in the after school program. c) Return check fees: fees shall incur as set forth in Florida Statute 68.064 as amended. Replacement payment for all returned checks must be made by certified check, or cashier’s check. If two returned checks are received, all future payments must be made by credit card, certified check or cashier’s check. ____Disenrollment policies. Initial I/We understand that if a child is in attendance on the 1st of a month, payment for that month will be due in full. Tuition payments are due no later than the 8th of each month during the school year or attendance will discontinue until payment is made and child may be disenrolled from the school. Summer camp fees must be paid in full according to the payment schedules. If not received by these dates, it will be grounds for disenrollment from the program. I/We understand that all fees not paid in full shall be subject to collection. I/We understand that there will be NO refund of registration fees. A child may be disenrolled by Cambridge Schools without prior notice if, in the sole opinion of Cambridge Schools, it is in the best interest of the child or Cambridge Schools. ____Withdrawal policies Initial If a child is in attendance on the 1st of a month, payment for that month will be due in full. I/We agree to notify the school in writing submitted to the office a minimum of 15 days prior to the first of the month during the school year and a minimum of 1 week prior to the start of any summer camp reserved week. Summer camp will require a $30.00 fee to be paid per week for any cancellations made regardless of advanced notification. I/We understand that there will be NO refund of registration fees. If a child withdraws and returns to Cambridge Schools during the same school year, payment will be due for the time missed and a new registration fee must be paid. Payment and Policy Agreement and Consent Page 2 ____Illnesses or Accidents Initial I/we understand that should my child ______________________________become ill or suffer an accident while she/he is in the care of Cambridge Schools, school staff will first attend to the child’s immediate needs and then will make reasonable efforts to contact me/us immediately. If the school staff deems it necessary, they are authorized to seek and obtain medical attention, treatment and service for my/our child through medical services (911). ____Emergency Care Initial I/we understand that Cambridge Schools does not provide on-site nurses or medical professionals, nor are there other emergency medical services available at the school. Only CPR and basic first aid are available until emergency medical services arrive. Cambridge Schools staff are not trained to provide medical care. I/we will notify the school in writing of any medical condition, illness, allergies, or other special need that my/our child has. I/we understand that Cambridge Schools has the right to deny admission, or discontinue attendance if they feel they are not able to safely care for the child. Cambridge Schools does not discriminate on the basis of disability or any other protected status. ____Severe Weather closing Initial I/we understand that in most circumstances, if County Schools close for severe storm warnings or any emergency situation, Cambridge Schools will also close. At this time, I/we must contact the school and immediately pick up my/our child, if required. In some circumstances, Cambridge Schools will be open on County School Emergency Days. It is my/our responsibility to contact the school to verify whether Cambridge Schools will be open. Tuition refunds will not be given for the days in which the school is closed. ____Family Handbook and “Know Your Child Care Facility Brochure”. Initial I/we will receive the Family Handbook prior to my child’s first day of school and sign an acknowledgement stating I/we have read all policies. I/We have received and read a copy of the “Know Your Child Care Facility Brochure”. ____Behavior Management Initial I/we have been advised that Cambridge Schools follow a child-oriented approach to behavior management. This includes, but is not limited to, such techniques as gentle reminders, ignoring negative attention seeking behavior and reinforcing the positive with praise and love. Food and fun are not withheld from the children. At no time is corporal punishment tolerated at Cambridge Schools. ___Mediation Initial I/we have been advised and agree that any dispute or claim arising out of or relating to the services provided by Cambridge Schools shall be submitted to nonbinding mediation prior to the commencement of arbitration, litigation, or any other proceeding before a trier of fact. The parties agree to act in good faith to participate in mediation and to identify a mutually acceptable mediator. If a mediator cannot be agreed upon by the parties, each party shall designate a mediator, and those mediators shall select a third mediator who shall act as the neutral mediator to assist the parties in attempting to reach a resolution. All parties to the mediation shall share equally in its costs. ____Health Regulations Initial I/we understand that the laws and regulations of the State of Florida require all students to have on file before attending the first day of class, specific records (health, immunization and physical) and required enrollment forms. Payment and Policy Agreement and Consent Page 3 ____Babysitting Policy Initial I/we understand that in an effort to maintain the professional status of Cambridge Schools staff and prevent any potential conflict of interest, babysitting by center staff members is discouraged. However, should I/we hire any school staff members for any off-site purposes, including, but not limited to: transportation, private tutoring, instruction, coaching, swimming lessons, or babysitting care, it must be outside the school premises and with the understanding that such arrangements and payment for services are solely between me and the school staff member. Cambridge Schools does not sanction the arrangements, and I/we agree to hold Cambridge Schools harmless from any such arrangement. ____Photographs/Video Permission Initial I/we give permission for my/our child to be photographed and videotaped in the school and during program functions and field trips. I/we understand that photographs/videos may be taken by school staff or by other parents/guardians. I/we will be notified if any photos/videos taken by school staff are to be used for public relations purposes and understand I/we have the right to refuse permission for such use. ___Children’s Confidential File Initial I/we understand that information about children is gathered routinely and confidentiality is maintained. Files are accessible to the Director, Assistant Director, other administration, teachers, social service agencies, legal and regulatory authorities and other appropriate school personnel as reasonably necessary. I/we also understand that all necessary forms must be in my child’s folder for him/her to attend school and any changes in the pertinent information in my/our child’s records must be provided within 5 days of the changes. ____Merger and Amendment Initial This Agreement embodies the entire representation, warranties, agreements and conditions in relation to the subject matter hereof, and no representation, warranties, understandings or agreements, oral or otherwise, in relation thereto, exist between the parties except as herein expressly set forth. This Agreement may not be amended or terminated orally, but only as expressly provided herein or by instrument in writing, duly executed by the parties hereto. I/we have read, understand and agree to the policies stated in this document. Date: _____________ Child’s Name: ___________________________________________ Signature of Parent/Legal Guardian: _____________________________________________ Print Name: _______________________________________________________________ Relationship to child: ________________________________________________________ Signature of Parent/ Legal Guardian: ____________________________________________ Print Name: _______________________________________________________________ Relationship to child: ________________________________________________________ Payment and Policy Agreement and Consent Page 4 Child’s Profile 2015-2016 Date: _______________ Child’s Name: _____________________ Date of Birth:_____________ Medical History Type of Birth: ___Normal ___Premature ____Complications Please explain:_______________________________ _________________________________________________________ Please list any conditions, illnesses, allergies, or special needs that we should be aware of: _________________________________________________________ _________________________________________________________ _________________________________________________________ Please list any medications that your child takes on a regular basis: _________________________________________________________ _________________________________________________________ Please list any special eating habits your child may have._______________ _________________________________________________________ Developmental History At what age did your child begin to walk?__________________________ How do you comfort your child?_________________________________ What are your child’s favorite activities?__________________________ _________________________________________________________ What language(s) is spoken in your home?__________________________ Do you have any concerns regarding your child’s speech or hearing?_______ If yes, please explain:_________________________________________ _________________________________________________________ Toilet Training Can your child be relied upon to indicate his/her bathroom wishes?_______ What words does your child use?________________________________ Are there any concerns you have about your child’s toileting?____________ _________________________________________________________ CONTINUE TO COMPLETE THE INFORMATION ON THE REVERSE SIDE OF THIS FORM Sleeping Do you have any specific ways of helping your child go to sleep?__________ _________________________________________________________ What is your child’s current sleeping schedule?______________________ _______________________________________________________ Social Experiences If there are other children living in your household, please complete the following: Name Age Gender Relationship to the Child _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Please list the names of the adults living in your household Name Relationship to the child _________________________________________________________ _________________________________________________________ _________________________________________________________ What past experiences has your child had playing with other children? _________________________________________________________ _________________________________________________________ ___I do not need to meet with an Administrator to further discuss my child’s specific needs. ___I do need to meet with an Administrator to further discuss my child’s specific needs. Please list any other information, medically or socially about your child that we should know. _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ __________________________ Parent/Legal Guardian Signature __________________________ Print Name Special Snack/Cooking Activity Permission Slip (2015-2016) Dear Parents, At Cambridge Schools as a part of our curriculum and learning activities we have a planned cooking activity/special snack planned each week. If the classrooms are eating/preparing something other than what is listed on our snack menu there will be a Home School Connection notice posted for your child’s classroom. This is an opportunity for families to contribute an ingredient for the activity and/or to let the teachers know that your child can NOT have something that is listed. The snacks are varied throughout the school year depending on the curriculum. Here is a list of some of the common ingredients that are used. This is not a complete list, so it is important that you look at the Home/School Connection that is listed each week to ensure that your child can participate. Common ingredients: celery, carrots, broccoli slaw, apples, bananas, strawberries, grapes, cream cheese, hummus, raisins, crackers, rice cakes, tortilla chips, cheddar cheese, tomatoes, butter, ice cream, yogurt, blueberries, raspberries, peas, salsa, ketchup, granola, eggs, milk, etc. In addition there will be some special events during the school year where other food may be served. I give my child, ________________________________________________, permission to participate in Special Snack/Cooking Activities and Special Events where food might be served at Cambridge Schools My child has the following allergies/dietary preferences so they may NOT have the following: ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ Parent’s Signature Date Family Insurance Information 2015-2016 Child’s Name: __________________________________ Date of Birth: ____________ Home Phone Number: ______________________ Primary Parent/Guardian’s name: ________________________________ Cell Phone Number: ______________ Work Phone Number: _________________ Other Parent/Guardian’s name: _________________________________ Cell Phone Number: ______________ Work Phone Number: _________________ I/we, the undersigned, have registered my/our child ______________________________________________________________ (Name of child) To attend Cambridge Schools (Operated by Knowledge Universe). ____My child will be covered by a Supplemental Student Accident Program (“SAP”) to reimburse out-of-pocket expenses not otherwise covered by my medical, dental, or accident insurance. Questions should be directed to the Cambridge Schools Student Accident Administrator at 1-800-352-4466, prompt 2. ____I’ve/we’ve attached a photocopy of my family insurance identification card. This policy will cover my/our child in the event of expense being incurred while participating in any school activities. I/we understand that I/we are responsible for any and all expenses not reimbursed by the Cambridge SAP for emergency and medical care of my/our child. I/we are also aware of day to day risks involved in school activities and will not hold Cambridge Schools or employees of Cambridge Schools responsible for any injuries that may be sustained during participation of activities at Cambridge Schools. I/we have read, signed and understand the Family Statement of Understanding. ________ Date ___________________________ Signature of Primary Parent/Guardian ________ Date ___________________________ Signature of Other Parent/Guardian ___________________ Print Name ___________________ Print Name Photograph/Video/Film Permission Form CENTER NUMBER 085007 EVENT DATE 2015-2016 I give my permission to Knowledge Universe Education LLC, its subsidiaries and affiliates and their representatives, permittees, contractors and assigns (collectively, and as used in this form, “Knowledge Universe”) for myself and my child/children to be photographed, videotaped or filmed at the below-described event. I consent to Knowledge Universe’s use of my or my child’s/children’s likeness in those media in Knowledge Universe’s publications, promotional and advertising materials (including third party media outlets) and on any website (whether in their original or an altered form) for any lawful purpose and acknowledge that those media are the sole property of Knowledge Universe. I understand and agree that this consent extends to third party media representatives, permittees, and contractors who photograph, videotape or film at the event. I waive any right to originals or copies of those media and to inspect or approve the media and their use by Knowledge Universe. I also, in consideration of my child’s/children’s participating in the event, (1) waive any claim I or my child/children may have, whether now or in the future, against Knowledge Universe or any third party relating to their use of the media, including any right to payment, royalty or any other compensation and (2) release and forever discharge Knowledge Universe from all claims, demands, and causes of action that I and/or my child/children, our heirs, representatives, executors, administrators, or any person acting on our behalf or on behalf of our estates have or may have by reason of this form. Event: All school related events and activities Names of Children: Please check: ____ Yes ____ No ____ In-House Only Parent/Guardian: By signing below, I represent that I am at least 18 years old and that I have read this form and fully understand its contents, meaning and impact. NAME (PLEASE PRINT) SIGNATURE 103552-OPS-GEN 5/11 © 2011 Knowledge Universe Education LLC. All rights reserved. DATE ORIGINAL – Center COPY – Parent / Guardian / Employee SWIM CENTRAL WATER SAFETY EDUCATION QUESTIONNAIRE Child Care Program: Cambridge School 2550 Glades Circle, Weston, Fl. 33327 Child’s Name: Date: Age: Parents Address: Yes 1. Has your child ever taken swim lessons? 2. Can your child roll over and float on his/her back? 3. Can your child swim to the side of the pool? 4. Have you taken a Community Water Safety Course? 5. Is anyone in your household certified in CPR? No Additional Comments: Please mail or fax this form to: SWIM Central 3700 NW 11 Place Lauderhill, FL 33311 Fax: 954-357-8077 Phone: 954-357-SWIM (7946) PROVIDERS: You must have documentation that this form has been submitted. If you faxed this form, write the date you faxed it here: If you mailed the original form, this one should be a COPY. Write date mailed here: Revised 11/1/2014 ***Health Form Reminder *** Attendance will not be allowed at any Cambridge Schools Without The Following Up To Date Health Forms ORIGINALS REQUIRED FOR CAMBRIDGE SCHOOLS PRESCHOOL STUDENTS COPIES ACCEPTED FOR ELEMENTARY STUDENTS VACCINATION RECORD (FORM DH-680) THIS FORM MUST NOT BE EXPIRED AND MUST INCLUDE ALL REQUIRED SHOTS FOR CHILD’S AGE AND MUST INCLUDE HEPATITIS B SHOTS, PNEUMOCONJU SHOTS AND VARICELLA OR VARIVAX VACCINE (CHICKEN POX) OR DATE OF CHICKEN POX DISEASE AND GOOD HEALTH CERTIFICATE (FORM DH 3040) THIS FORM IS VALID FOR 2 YEARS FROM THE DATE OF THE LAST PHYSICAL. THESE FORMS ARE AVAILABLE FROM A FLORIDA PEDIATRICIAN or www.flshots.com OUT OF STATE OR COUNTRY FORMS ARE NOT ACCEPTED. NO CREDITS WILL BE GIVEN TO YOUR ACCOUNT FOR MISSED DAYS IF YOUR FORMS HAVE NOT BEEN SUBMITTED TO OUR SCHOOL OR HAVE EXPIRED. Cambridge School at Weston SCHOOL TUITION MONTHLY PAYMENT SCHEDULE 2015-2016 TODDLERS M-F M-F Start date End date 8/24/2015 Sept - May 6/9/2016 Annual tuition August pmt Monthly pmt June pmt Full day 8:30 a.m. - 3:00 p.m. 1/2 day 8:30 a.m. - 12:00 p.m. $10,380.00 $9,220.00 $280.29 $248.94 $1,085.99 $964.63 $325.80 $289.39 TWOS M-F Full day 8:30 a.m. - 3:00 p.m. M-F Bilingual F.T. 8:30 a.m. - 3:00 p.m. M-F 1/2 day 8:30 a.m. - 12:00 p.m. $10,265.00 $10,600.00 $9,105.00 $277.17 $286.39 $245.82 $1,073.96 $1,108.96 $952.60 $322.19 $332.97 $285.78 THREES M-F Full day 8:30 a.m. - 3:00 p.m. M-F Bilingual F.T. 8:30 a.m. - 3:00 p.m. M-F 1/2 day 8:30 a.m. - 12:30 p.m. $10,075.00 $10,430.00 $9,250.00 $272.05 $281.56 $249.74 $1,054.08 $1,091.23 $967.77 $316.23 $327.37 $290.33 PRE-KINDERGARTEN PreK with VPK 8:30 a.m. - 12:00 p.m. PreK Bilingual 8:30 a.m. - 12:00 p.m. PreK without VPK 8:30 a.m. - 3:00 p.m. $7,890.00 $8,240.00 $10,910.00 $213.04 $222.47 $294.61 $825.48 $862.10 $1,141.44 $247.64 $258.63 $342.43 BEFORE AND AFTER CARE PROGRAMS Before Care 7:00 - 8:30 a.m. Monday through Friday Start date End date 8/24/2015 Sept - May 6/9/2016 Annual tuition August pmt Monthly pmt June pmt $300.00 $8.07 $31.39 $9.42 After Care 3:00 p.m. to 6:00 p.m. Monday through Friday $1,200.00 $32.39 $125.55 $37.66 Note: Winter Break, Spring Break and Summer Camp are optional programs that require separate registration and fees. They are not included in the school year fees. 2550 Glades Circle, Weston, FL 33327 ENROLLMENT FORM VPK 3-HOUR PROGRAM 2015-2016 SCHOOL YEAR (4 YEARS OF AGE BY SEPTEMBER 1, 2015) MONDAY – FRIDAY – 3 hours per day TODAY’S DATE:__________________ DATE TO START SCHOOL:_______________________ CHILD’S NAME:_____________________________________ DATE OF BIRTH:__________________ PARENT’S NAME(S):_________________________________________________________________ ADDRESS:_________________________________________________________________________ HOME PHONE NUMBER:_____________________ WORK PHONE NUMBER:______________________ CELL PHONE NUMBER:______________________ EMAIL:__________________________________ I/we agree to enroll my/our child in the VPK Program for the 2015-2016 school year. I/we understand that the State VPK Child Eligibility and Enrollment Certificate must be submitted along with all other Cambridge Schools VPK participation forms, enrollment forms and medical forms required to attend the school. AFTER SCHOOL PROGRAM AVAILABLE UNTIL 6:00 P.M. Check to enroll ___ Monday – Friday Full School Year Fee Aug pmt. Sept-May pmts. $1194.73 $32.39 $125.55 nd All payments due on the 2 of each month. June pmt. $32.39 ____________________________ Primary Parent/Legal Guardian Signature ________________________________ Other Parent/Legal Guardian Signature ____________________________ Print Name ________________________________ Print Name *** Voluntary PreKindergarten *** Policies for Families Enrolled in the VPK Program 2550 Glades Circle, Weston Fl. 33327 954-217-8566 2015-2016 Child’s Name:______________________________ Parent’s Name:______________________________ These policies are in addition to the Cambridge Schools Family Statement of Understanding and are specific to the State Sponsored VPK Program. All parents whose children are participating in VPK at Cambridge Schools must sign an agreement to ensure all policies are understood. Please read carefully, initial each section and sign. Families who are participating in the VPK program. Must be present during the scheduled hours of the program each day to be eligible for the VPK program. Students will follow the Cambridge Schools VPK calendar and will participate in all VPK activities. ____ Sign In/Out Procedure Initial I/we understand that it is State mandated for all families participating in the VPK program to keep accurate attendance records. Parents and guardians must sign children in and out everyday with their full signature. Payment from the state is based on attendance records. Appropriate payment is not possible if attendance is not accurately documented. Parents and guardians must sign their first and last name. No initials are accepted. Signatures must be legible. PARENTS AND GUARDIANS MUST SIGN IN AND OUT EACH DAY, AT ARRIVAL AND DISMISSAL TIME. Signing in or out cannot be done in advance of the actual time. ____ Monthly Attendance Verification for Parents Initial I/we understand that the State requires Cambridge Schools to document each child’s attendance on a monthly basis. Parents and guardians will be responsible for signing an Attendance Verification Form at the end of each month. The forms will be available at the front desk, ready to be signed on the last school day of each month. THIS FORM MUST BE COMPLETED EACH MONTH. Parents and guardians must sign with their first and last name. No initials are accepted. All signatures must be legible. ____ Attendance Policy Initial I/we understand that if a child does not begin attendance on the first day of the school year, parents or guardians must complete a Delayed Enrollment Form. Students will not be eligible for the full VPK 540 hours. ____ Absence Policy Initial I/we understand that students are expected to attend at least 80% of the VPK Program and are ONLY allowed absences less than or equal to 20% of the scheduled VPK class time per month. Exceeding the number of days allowed for VPK absences could lead to withdrawal from the program. ____ Uniform Policy Initial I/we understand that Cambridge Schools is a uniform school. A Cambridge Schools shirt or dress is required to be worn every day. Each school has a clothing store in which you can purchase uniforms. Any shorts or pants are acceptable. Closed toed shoes or sneakers are required. Sandals, Crocs® and other open toe shoes are not allowed. If a child arrives without the approved uniform, the parent will be called to deliver the necessary clothing or authorize a purchase for the needed item(s). ____ Late Pick-Ups Initial I/we understand that our child must be picked up by the end of his/her scheduled hours or school closing hours for those enrolled in optional after school or a late pick up fee of $3.00 per minute will be charged. ____Optional Fees Initial I/we understand that Parents or guardians are responsible for payment of all optional fees not covered by the VPK Program. This may include but is not limited to lunches, uniforms, after school and enrichment programs. If payments are not received by due dates, the provider may discontinue enrollment in the VPK program. ____ Returned Check fees Initial I/we understand that all returned checks shall incur a charge as set forth in Florida Statute 68.064 as amended. If two returned checks are received, all future payments must be made by credit card, certified check or cashier’s check. ____ Behavior Management Initial I/we understand that Cambridge Schools follow a child-oriented approach to behavior management. This includes, but is not limited to techniques such as gentle reminders, ignoring negative attention seeking behavior, redirection, and reinforcing the positive with praise and love. Food and fun are never withheld from children. At no time is corporal punishment tolerated at Cambridge Schools. ____ Behavior Policies Initial I/we understand that children and families are expected to respect all staff, children and materials. If there is a concern about a child’s behavior, parents will be called and will meet with the Director to plan a course of action. We reserve the right to withdraw a child when we determine that the program is not appropriate for the child or the family. If a VPK family has a concern, the Director’s door is always open to resolve all concerns. Each case is handled individually. ____ Additional Programs Offered Initial I/we understand that Winter Break, Spring Break and Summer Camp Programs are separate from VPK Programs and are available for an additional fee to all students. ____ Withdrawal and Disenrollment Policies Initial I/we understand that if a child is absent from VPK for five consecutive days, without an excused absence, the child will be automatically withdrawn from the program. A parent or legal guardian may withdraw a child with or without reason at anytime. A child may be dismissed by the school at anytime if the family does not comply with the Policies for Families Enrolled in the VPK Program. I/we have read, understand and agree to the policies of VPK and Cambridge Schools described above and agree to abide by this agreement. Date:____________ Child’s Name:_______________________________________ __________________________________ Primary Parent/Legal Guardian (Print Name) _________________________________ Primary Parent/Legal Guardian Signature Relationship to child:____________________________________________________________ ______________________________________ Other Parent/Legal Guardian (Print Name) _________________________________ Other Parent/Legal Guardian Signature Relationship to child: _____________________________________________________________ These policies are subject to change without notice.
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