RED APPLE PRIVATE SCHOOL & CHILD CARE 7605 Bissonnet Houston, Texas 77074 (713) 771-7913 ` ENROLLMENT APPLICATION AND AGREEMENT Date _____________________________ 1st Day of Enrollment _______________________________ Date of Withdrawal ______________________ Child’s Name ___________________________________________________________________ Date of Birth ______________________Sex_______ First Last Nickname Child’s Address ___________________________________________________________________________________ Current Age _______________ Street City State Zip Days Contracted to Attend _________________________________________________________ Hours Contracted to Attend ______________________ After School – Elementary School attending: _______________________________________________________________________________________ The Child will be released only to the person(s) signing this application plus the following persons: Name Address Phone Relationship _________________________________________ __________________________________ ______________________ _____________________ _________________________________________ __________________________________ ______________________ _____________________ Father/Guardian Name ____________________________________________________________________ Home Phone ________________________ State Driver’s License # ______________________________________________________________ Birth Date _________________________ Employed By _________________________________________ Address_____________________________ Phone ____________________________ Mother cell phone ___________________________________________ Father cell phone________________________________________________ Mother/Guardian Name ____________________________________________________________________ Home Phone ________________________ State Driver’s License # ______________________________________________________________ Birth Date _________________________ Employed By _________________________________________ Address________________________________ Phone _________________________ Pediatrician’s Name _______________________________________________________________________ Phone ____________________________ Address ___________________________________________________________________________________________________________________ Emergency Contact Other Than Parent or Doctor Name________________________________ Phone ____________________ Name_____________________________ Phone ____________________ Address _______________________________________________________ Address _____________________________________________________ My child (does) _____ (does not)______ have my permission to participate in Red Apple field trips. My child has the following allergies: ______________________________________________________________________________________________ I (do) _______ (do not) ________ give permission for the administering of non-aspirin to my child. I (do) _______ (do not) ________ give permission for my child to be photographed and the photographs to be displayed. I learned about Red Apple through ________________________________________________________________________________________________ I chose Red Apple because_______________________________________________________________________________________________________ TERMS 1. I agree to pay on Monday or before (or the first day contracted to attend) for each week a tuition fee of $_______ with no deductions for absence or holidays. A late charge of $25.00 will be added to my child’s tuition fee if not paid by Monday. If the tuition is not paid per this agreement, my child’s enrollment will be discontinued. 2. I agree to pay a non-refundable registration fee at the time of enrollment and each school year (beginning August 15th). 3. I understand that if my child is absent one week or more (or present only one day of one week) for the days or hours contracted to attend, I will pay half of the tuition fee shown. The full tuition is due if the child is present for two or more days. If this fee is not paid in advance, I understand that my child’s enrollment may be discontinued. Red Apple allows one week per year for vacation after a year’s continuous attendance. 4. I agree to pay a late pick-up fee if my child is left I the Center after 6:30 p.m. as described in the attached Policies and procedures Agreement. 5. I agree to pay a $25.00 fee for a bad check and that if I give a bad check to Red Apple I may no longer pay by check. 6. In case of withdrawal of my child from the Center, I agree to give the Center a one-week notice prior to withdrawal. If this notice is not given, I agree to pay one week’s extra tuition fee prior to withdrawal. 7. In the event of an emergency illness, the Red Apple School has my permission to administer medication as it sees fit in the child’s best interest. In the event of illness while the child is in attendance, medical expenses are the responsibility of the parent. 8. I agree to carry out the parents’ responsibilities under the Policies and Procedures Agreement between Parents and Red Apple School as same may be changed from time to time by Red Apple. 9. Should the Director of the Center determine that my child cannot adjust to the Center’s program, the child will be withdrawn after two weeks notice and this Agreement will be terminated. 10. This Parent’s Contract is subject to change at the sole discretion of Red Apple School. 11. I understand that I will be responsible for all reasonable collection costs and attorney fees. ___________________________________________________ X______________________________________________________Date ___________ Signature of Director Signature of Applicant (Parent or Guardian) Transportation Agreement 1. ________________________________________________________________hereby give permission for my child ________________________________to ride in the vehicle provided by Red Apple School. My child will be transported from Red Apple School to ________________________________and that school will assume full responsibility until (he) or (she) is on board the Red Apple School vehicle. My child will be picked up at _____________________________ and transported to Red Apple School. The Red Apple vehicle will depart at ___________ (am) (pm) and ____________(am) (pm) for the above school. 2. I also give permission for my child to ride in the vehicle provided by Red Apple School for any field trips arranged by Red Apple School. ___________________________ X_____________________________________________________________ Date Signature of Parent or Guardian Authorization for Emergency Medical Attention In the event I cannot be reached to make arrangements for emergency medical attention, I authorize Red Apple School, its staff and/or assigns to seek the closest medical facility available. I give consent for any and all necessary treatment when my child is in the care of this physician and/or hospital/clinic. __________________________ X______________________________________________________________ Date Signature of Parent or Guardian