Brush Creek Montessori School Primary Application Form

Brush Creek Montessori School

1569 Brush Creek Road, Santa Rosa, CA 95404, 707 539-7980, Fax 707 539-7549

Primary Enrollment Form 2008-2009

Student's Name_______________________________

Home Phone_________________________

Birthdate_____________________________

M / F (circle one)

Email Address ____________________________________________________________________

Address__________________________________________________________________________

City_______________________________________________Zip____________________________

Parent #1 Name _____________________________ Occupation____________________________

Parent #1 Work Phone________________________ Cell Phone_____________________________

Parent #2 Name _____________________________ Occupation____________________________

Parent#2 Work Phone________________________ Cell Phone_____________________________

My child will attend:

5 FULL DAYS (9:00 - 3:00)
$7,400 per School Year
Installments $740

5 HALF DAYS (9:00-12:00)
$6,000 per School Year
Installments $600

Tuition Payable as follows:

1. At the time of enrollment, a non-refundable deposit fee of $50 must accompany this form. If your child is accepted, this fee will go towards the Registration Fee ($100) and Materials Fee( $400.)
2. A check for the June/2009 tuition must be submitted when your child is accepted.
3. The balance of the yearly tuition will be billed in nine monthly installments due each month from September 1, 2008 through May 1, 2009.
4. A late fee of $50/month will be assessed for any overdue balance.
5. An option to pay the full-year tuition is available at a 3% discount (Sept. 15, 2008 deadline)
6. Visa and Master Cards are accepted.
7. Refunds can only be made if you move from Sonoma County.
8. A fee of $25 will be assessed for all returned checks.
9. Any modification of these terms must be in writing, signed by both parties.
10.Scholarships available to full-time students only.

Hours/Materials Contribution (Outlined in the Community Handbook)

(Please initial one of the following choices)

___ Our family would like to participate in 25 Community Service Hours this year

And/Or

___ Our family would like to participate in the BCMS Community Service hours, but would rather contribute $450.00 (tax deductible) towards school maintenance/ development.

I ACCEPT THE ABOVE TERMS.

Parent's/Guardian's Signature: ____________________ Date:____________________

BRUSH CREEK MONTESSORI ENROLLMENT CHECKLIST

I have observed a class in session.
My child has visited the class.
I have read the Community Handbook.

Parent's/Guardian's Signature: ____________________ Date:____________________

Payment	Check Number	Amount Paid
Registration Fee
Materials Fee
Tuition

Office Signature: ______________________________ Date:____________________