ACTON-BOXBOROUGH COMMUNITY EDUCATION EXTENDED DAY KINDERGARTEN PROGRAM, 2016-2017 ADMINISTRATION BLDG., 15 CHARTER RD., ACTON, MA 01720

(978) 266-2525

Child’s Name(last, first)_________________________________

DOB_________ Gender: M / F

Home Address_________________________________________

Home Phone____________________

Program: Admin___ Conant ___Gates ___

Requesting All-Day Kin Yes/ No

Father/Guardian Name ___________________________

Mother/Guardian Name _______________________

Business Phone ________________________________

Business Phone _____________________________

Cell Phone_____________________________________

Cell Phone _________________________________

Email Address __________________________________

Email Address ______________________________

MONTHLY TUITION -SCHEDULE Please: Check the box to indicate the number of days per week and circle the days of the week and column.

If your child is in:

½ Day Kindergarten either AM or PM

And you need Extended Day:

½ Day ExD only

½ Day ExD + Early AM

½ Day ExD + Late PM

½ Day ExD +Early AM +Late PM

Early AM

Late PM

Early AM + Late PM

$445

$627

$782

$870

$222

$562

$678

Full Week – Five days

A

All Day Kindergarten

Please circle the Days 4 days

M

T

W

Th

F

$418

$550

$682

$782

$194

$470

$558

3 days

M

T

W

Th

F

$319

$423

$529

$605

$153

$354

$423

2 days

M

T

W

Th

F

$228

$290

$367

$409

$106

$236

$286

F

$122

$158

$195

$216

$54

$127

$154

1 day 

M

T

W

Th

An additonal fee of $25/month will be charged for children attending on Thursdays Late PM due to the early release days afternoons. Not applicable to those attending 5 PM days.

REGISTRATION FEE $40.00. (Maximum registration fee per family $75.00) Note: Fees are non-refundable, except for those children who enroll in All Day Kindergarten and do not require school hour care. Registration Paid $_________________

If my child is accepted, I understand and agree to the following:   

Tuition is paid in 10 equal payments with the first non-refundable June 2017 payment due by August 1 and monthly thereafter. st If you register after August 1 , the first payment will be the non-refundable tuition for June 2017 plus the current month. Transportation to the program in the morning and pick-up at the close of Extended Day is the responsibility of the pare nt. It is presumed that the child is enrolled for the full academic year. We require written notice by the 10 th of the month for a schedule change to occur the following month. There is a one month notice required for withdrawal. See Policies and Procedures document for details .

Parent Signature:________________________________

Date: ____________________________