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Student Application and Parent Contract
STUDENT APPLICATION FOR ENROLLMENT
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Child Information: |
Last Name: ______________________________ First Name: __________________________
Address: ____________________________________________________________________________
Date of Birth: __________________ Age:______ Date of Enrollment: ________________ Sex: _
For the future, we are interested in private school education for the following grades (Please circle):
Toddler Preschool Pre-K K 1 2 3 4 5 6 7 8
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Family Information: |
Mother’s Name: _________________________ Father’s Name _________________________
Address: ______________________________ Address: ______________________________
Zip: ______________________________ Zip: ______________________________
Home Phone: _______________________ Home Phone: ___________________________
Cell Phone: _________________________ Cell Phone: ___________________________
Work Phone: _________________________ Work Phone: __________________________
Sibling Name: ______________________________ Age: _____ Current School: ________
Sibling Name: ______________________________ Age: _____ Current School: ________
Person Assuming Tuition Responsibility: ________________________________________(must sign contract)
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Medical Information: |
I hereby grant permission for the staff of Brookfield’s TLC to contact the following medical personnel and to obtain emergency medical care if warranted.
Doctor: ______________________________ Phone: ______________________________
Dentist: ______________________________ Phone: ______________________________
Please list allergies, special medical or dietary needs, or other areas of concern:
____________________________________________________________
____________________________________________________________
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Contacts: |
Your child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to release the child from BROOKFIELD’S TLC in case of illness, accident, or emergency, if for some reason the custodial parent or legal guardian cannot be reached:
Name: ___________________________________________ Work#: ___________ Home#: __
Name: ___________________________________________ Work#: ___________ Home#: __
Name: ___________________________________________ Work#: ___________ Home#: __
Name: ___________________________________________ Work#: ___________ Home#: __
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Custody: Mother: __________ Father: _________ Both: ______ Other: _________________ |
Helpful information about your child:
I give permission for my child to be photographed and understand that my child’s photo may appear in Newspaper articles, on BROOKFIELD’S website, and other professional and community publications.
Signature _________________________________________________ Date:___________________
LIBRARY AND NATURE WALKS PERMISSION FORM
I give permission for my child to go on a walk to local parks and libraries as a supervised class outing. I understand it is my responsibility to let the center know if my child may not attend.
Signature _________________________________________________ Date:___________________
I have read and understand the BROOKFIELD policies, contract, and rules. I understand that a current certified immunization record and a Well Child check up form must be on record prior to attendance.
Signature of Parent/Guardian Date
Signature _________________________________________________ Date:___________________
Rev:10/03
Family Financial/ Behavior Agreement for Family of Student(s):Brookfield School and Brookfield TLC (hereafter referred to as "Brookfield") welcome all applicants regardless of race, religion, gender, or national origin. Religion is not taught but ethical behavior, personal integrity and responsibility are stressed. Admission is invitational after free screening on ability to meet curriculum goals, which does not guarantee availability.
If accepted for admission, and with payment of application and enrollment fees, please enroll the above-named student(s) at Brookfield subject to annually-issued rules, regulations, conditions, traditions and financial terms in Student and Parent Handbook, Calendar, Fee Schedule, and Admissions/Placement policies (collectively, "The Handbook"), which are an acknowledged part hereof. This agreement is in effect for family and students enrolled at Brookfield until a new agreement is signed.
The application fee applies to all new applicants.
The enrollment fee is for all students each school year. This fee is non-refundable once Brookfield accepts the student. The enrollment fee (See Fee Schedule) constitutes good faith in binding this contract.
Parents/guardians agree to pay all tuition and fees for each school year, according to the payment plan. No refund for parent/guardian chosen enrollment changes after July 1. Students are enrolled for the entire academic year unless expressly agreed to in writing by both parties. Should application be withdrawn before July 1, prior to entry, enrollment fee is retained by Brookfield. After July 1, tuition and fees for the next school year are due. Brookfield is an invitational school and may terminate student attendance for any reason, including those set forth in The Handbook, or if tuition is unpaid and overdue by the 15th of the month.
Tuition applies to the 180-day school year. Specialty programs: summer school, vacation camps, extended care occur outside the 180 days and are not included in tuition. The number of school days per month and monthly payment do not always correspond, and holidays are not used in calculating tuition payments.
Payment plans are available based on two, four, ten, or eleven payments per year. Tuition plans are calculated by dividing total tuition strictly by the number of payments selected. Tuition is due on the first of the month; first payment is due July 1st or August 1st depending on payment plan. A full tuition payment is due in December and June despite the fewer number of class days in these months.
Visa and Master card are accepted; a transaction fee is added.
All students are expected to leave campus immediately after class or school-sponsored activities end; Brookfield offers appropriate supervision on campus, before and after school, for an additional fee.
A sibling discount is applied for full-time students only. Full tuition applies to the oldest child in a family with more than one child enrolled. There is no discount for part-time TLC students.
Written notice of withdrawal must be received at least 30 days in advance. Tuition is not prorated for early withdrawals. Fall withdrawals must be received before July 1st. After July 1st the Annual tuition is due.
Unless written agreement is made, a student may be asked not to attend class until tuition is paid.
A late fee is charged on any unpaid balance on the 10th of the month or for returned checks. Past due accounts accrue interest at 24% per annum.
Tuition's are prorated for midyear enrollments. This typically requires a payment in June. Tuition adjustments are calculated using the daily rate and number of days enrolled.
Tuition is not reduced for absence, voluntary or involuntary withdrawal, or expulsion and deductions, refunds, make-up days are not given for any absences.
Brookfield may contact schools and other sources for information to support this application; all information and evaluation materials are confidential and are not provided to family members. No person or institution shall be liable in any way for providing such information.
Brookfield’s may not be able to identify learning disabilities, developmental delays, or academic challenges.
Brookfield makes every effort to accommodate individual needs, it is impossible to deal with all problems and the school cannot compromise standards to the detriment of the student body; therefore, all students are probationary. Children may be asked to leave Brookfield at any time.
A positive relationship between Brookfield, student, and parents/guardians is essential. As an invitational school, Brookfield may dismiss or refuse enrollment a student, if the student, or parent(s)/guardian(s) disrupt the education process or jeopardize the learning environment. For any reason not prohibited by law, conduct in violation of The Handbook, detrimental to the student, disruptive to other students, or unacceptable academic performance, may result in disciplinary action, including suspension or dismissal.
Children must be toilet-trained; repetitive "accidents" may be grounds for suspension.
All students before attending the first day of class must have on file, specific records (immunization, physical, emergency contacts, and health) to comply with local and state regulations.
Class size and teacher-pupil ratio may vary.
A change fee applies to all parent-requested schedule changes in attendance after July1st.
Annual enrollment begins each spring for the coming school year and is based on; progress, behavior, parental support, and prompt application. Priority goes to qualified returning students and their siblings whose accounts are current. Available space is then offered to qualified wait listed students. Grade/classroom placement is governed by Brookfield; it is not a part of this or subsequent contracts.
An annual non-refundable enrollment fee applies to all students. The annual enrollment fee (See Fee Schedule) constitutes good faith in binding this contract.
Limited partial scholarships are available for families in financial need. The Tuition Assistance Committee determines funds disbursement in strictest confidence. A form and enrollment deadline is strictly enforced, and must be accompanied by the previous year’s 1040 tax returns and W2 forms. This program is separate from admission decisions.
If attorney services for enforcement and/or collection are initiated, the undersigned shall pay all costs and fees.
Brookfield is not responsible for loss or damage of personal belongings.
Students photographs and information may be used in school publications without compensation or fee.
If Brookfield determines a child needs emergency medical care or treatment, medical or otherwise, Brookfield may furnish oral or written consent for said treatment or emergency care without subsequent liability, as such should be given as soon as possible. All expenses incurred by Brookfield in providing such treatment or medical care shall be the sole responsibility of the legal parent/guardian.
Both campuses are closed the last two weeks of August; see the school calendar.
Parents/guardians and students agree to abide by Brookfield Behavior Standards and understand that violation may result in suspension or expulsion.
An exemplary learning environment requires the full support of parents and students; you must agree to abide by this document prior to signing below. Parent/Guardian agrees to pay all tuition and fees each school year.
I agree to fully abide by the Policy Agreement, Parent/Student Handbook, and Behavior Standards.
I recognize the authority of the teacher and principal regarding curriculum, methodology, assessment, and homework.
I will take an active role in my child’s education by daily reviewing homework, supporting school functions, and communicating with teachers.
I will handle misunderstandings respectfully and directly with teachers and administration. It is my responsibility to inform Brookfield staff of misunderstandings so the relationship between school and home remains strong.
I support Brookfield discipline.
I understand that my child’s attendance is contingent upon academic performance and behavior and by my abiding by Brookfield policies.
Date Mother (or legal guardian) Legal guardian/Responsible Party Father (or legal guardian)
4th through 8th Grades Student Behavior Agreement
I understand that drug, alcohol, and tobacco use, whether on or off campus, is strictly forbidden.
I understand that threats (including internet messages) whether on or off campus, are strictly forbidden.
I have read, understand, and will abide by the Brookfield Handbook’s behavior standards.
I understand the Internet use policy and agree to abide by the Brookfield rules both on campus and away.
Brookfield may use my photograph and information in school publications.
___________ _____________________________________________________________________________
Date 4th - 8th grade student signature
____________
_____________________________________________________________________________________
Date mother father legal guardian signature of person responsible for billing
required
Mail completed application with $50.00 fee to, Brookfield’s Toddler Learning Center, 185 Redfield Parkway., Reno, NV 89509
Brookfield's TLC 185
Redfield Parkway Reno, NV 89509 775-825-3003
Email: brookfieldtlc@gbis.com
Fax: 775-825-3463