2019-20 ACADEMIC YEAR APPLICATION CONTRACT 2-3 YEAR OLD TODDLER PROGRAM 2019-20 ACADEMIC YEAR APPLICATION CONTRACT 2-3 YEAR OLD TODDLER PROGRAM Step 1 of 2 50% If you are interested in having your child or children attend Village Green Montessori, please complete this form (one for each child) and submit to VGM. You will be invoiced an application fee of $200.00. Once your payment has been received, your space will be reserved. In the event our class is full, you will be placed on the waiting list at no charge. * Please note: Hot lunch is a requirement for our 2-3 year old classroom per DCFS. There will be an additional charge of $5 per lunch, per scheduled days - billed semi-annually August and January. ** Attention: If your child will be 3 years old and toliet trained by September 1st, please fill out the 3-6 Pre-K application.I already have an account on villagegreenmontessori.hubbli.com*YesNoUsername (please use this format "momsnameanddadsnamelastname")*Child's Full Name (Nickname)Child's Name (Nickname)* First Middle Last Sex*MFDate of Birth* Place of BirthYear started at VGM*PRIMARY CONTACT PERSON* First Last 1st person to contact in case of a child's illness or emergencyPRIMARY CONTACT PHONE*Please provide the number we should call firstHome Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneParent's Primary Email Address* Marital Status*MarriedSeparatedDivorcedSingleCustody AgreementIf you are divorced or separated, we require a copy of the custody agreement on file at VGM. Please contact us if you have any questions.Mother's Name*OccupationName of FirmBusiness PhoneCell Phone*Date of Birth Father's Name*OccupationName of FirmBusiness PhoneCell Phone*Date of Birth Names/Age of SiblingsClick + sign to add moreNameAge Elementary school your child will attend*A - AdlerB - ButterfieldC - CopelandR - RocklandGN - GurneeGL - GrayslakeOG - Oak GroveRD - RondoutOtherHow did you hear about our school?List any other members of the household and their relationship to childNameRelationship to Child Click + sign to add morePhoto Release: I give my permission for my child’s photo to be posted on the VGM website, VGM’s Facebook page and/or school advertisement. I understand my child’s name will not be used.*YNSchool Directory & Class Lists: I give permission for my child’s information to be published on class lists and in the school directory. The information included may be: name, address, home phone, name of parents and email addresses.*YNDoctors Name* First Last Doctors Phone Number*Does you child have allergies?*YNPlease list Allergies (including food) Click + sign to add moreDoes you child take medication?*YNPlease list Medications your child takes regularly or for emergencies* Please note: If any medication (prescribed or OTC) needs to be given during school hours: A VILLAGE GREEN MONTESSORI, INC. will not dispense medication to a minor child/ward or other participant, nor shall any student possess or consume any prescription or non-prescription medication (OTC) unless the Physician’s Authorization and Permission for Administration of Medication, Permission to Dispense Medication, and the Medication Dispensing Information forms are signed and have been filed with the school. These forms must be in our office before we can administer any medication. Click + sign to add moreDoes you child have any chronic medical conditions?*YNPlease list Chronic medical conditions* Click + sign to add more 2's & 3's Morning Program Options No Sibling discounts are available with this program Tuition Installment Plan is for 10 installments - due June 1st and August 1st- April 1st Two Morning Option Tuition Days Available 8:30-11:30 $380/Installment $3800/Year Tuesday/Thursday 8:30-12:30 $476/Installment $4760/Year Tuesday/Thursday ($5 per lunch, per scheduled days - billed semi annually Aug and Jan) Three Morning Option Tuition Days Available 8:30-11:30 $466/Installment $4660/Year Monday/Wednesday/Friday 8:30-12:30 $608/Installment $6080/Year Monday/Wednesday/Friday ($5 per lunch, per scheduled days - billed semi annually Aug and Jan) Four Morning Option Tuition Days Available 8:30-11:30 $550/Installment $5500/Year Monday-ThursdayTuesday-Friday 8:30-12:30 $732 /Installment $7320/Year Monday-ThursdayTuesday-Friday ($5 per lunch, per scheduled days - billed semi annually Aug and Jan) Five Morning Option Tuition Days Available 8:30-11:30 $633/Installment $6330/Year Monday-Friday 8:30-12:30 $842/Installment $8420/Year Monday-Friday ($5 per lunch, per scheduled days - billed semi annually Aug and Jan)2's & 3's Extended Day Program Options No Sibling discounts are available with this program Tuition Installment Plan is for 10 installments - due June 1st and August 1st- April 1st Three Extended Day Option Tuition Days Available 8:30-3:30 $782/Installment$7820/Year Monday/Wednesday/Friday 7:30-4:30 Includes Early Bird a Alter School Club $1016/Installment $10160/Year Monday-Friday ($5 per lunch, per scheduled days - billed semi-annually Aug and Jan) Four Extended Day Option Tuition Days Available 8:30-3:30 $938/Installment $9380/Year Monday-ThursdayTuesday-Friday 7:30-4:30 Includes Early Bird & After School Club $1182/Installment $11820/Year Monday-Friday ($5 per lunch, per scheduled days - billed semi-annually Aug and Jan) Five Extended Day Option Tuition Days Available 8:30-3:30 $1079/Installment $10790/Year Monday-Friday 7:30-4:30 Includes Early Bird & Atter School Club $1388/Installment $13880/Year Monday-Friday ($5 per lunch, per scheduled days - billed semi-annually Aug and Jan)Please select your choice2's & 3's Morning Program Options2's & 3's Extended Day Program Options2's & 3's Morning Program OptionsTwo Morning OptionThree Morning OptionFour Morning OptionFive Morning OptionTwo Morning Option8:30-11:30 (Tuesday/Thursday) ($380/Installment $3800/Year)8:30-12:30 (Tuesday/Thursday) ($476/Installment $4760/Year)Three Morning Option8:30-11:30 (Monday/Wednesday/Friday) ($466/Installment $ 4660/Year)8:30-12:30 (Monday/Wednesday/Friday) ($608/Installment $6080/Year)Four Morning Option8:30-11:30 ($550/Installment $5500/Year)8:30-12:30 ($732/Installment $7320/Year)8:30-11:30 (please choose days)Monday-ThursdayTuesday-Friday8:30-12:30 (please choose days)Monday-ThursdayTuesday-FridayFive Morning Option8:30-11:30 (Monday-Friday) ($633/Installment $6330/Year)8:30-12:30 (Monday-Friday) ($842/Installment $8420/Year)2's & 3's Extended Day Program OptionsThree Extended Day OptionFour Extended Day OptionFive Extended Day OptionThree Extended Day Option8:30-3:30 (Monday/Wednesday/Friday) ($782/Installment $7820/Year)7:30-4:30 (Monday-Friday) ($1016/Installment $10160/Year)7:30-4:30 (Please choose three days) Monday Tuesday Wednesday Thursday Friday Four Extended Day Option8:30-3:30 (Monday-Friday) ($938/Installment $9380/Year)7:30-4:30 (Monday-Friday) ($1182/Installment $11820/Year)8:30-3:30 (Please choose days)Monday-ThursdayTuesday-Friday7:30-4:30 (Please choose only four days) Monday Tuesday Wednesday Thursday Friday Five Extended Day Option8:30-3:30 ($1079/Installment $10790/Year)7:30-4:30 ($1388/Installment $13880/YearAdmission/Tuition Policies*I understand that students are admitted to the A Village Green Montessori for the full academic term from August through June and that my agreement to pay tuition for the academic term is not subject to adjustment because of illness, absence, or withdrawal. In order to reserve a place for your child, an application fee of $200.00 is required. A first installment is due on or before June 1, 2019. These amounts are not refundable.*I understand hot lunch procured by VGM is a DCFS requirement. For the 2019-2020 school year, the cost is $5.00 per lunch, per the students scheduled days and you will be billed semi-annually - August and January. A snack fee of $40.00 per child for the year will be collected when school begins.*I understand that all children must be 2 years old by the first day of school to be accepted into the Montessori 2's & 3's Program.Signature of Parent/Guardian*Date This iframe contains the logic required to handle Ajax powered Gravity Forms.