Child Information Last Name * First Name * Middle Initial Birth Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Gender * - Select -MaleFemale Home Phone * Mailing Address Street * City * State * Zip * Parent/Guardian Information Parent/Guardian’s Name * Parent/Guardian’s Occupation * Work Phone * Cell Phone * E-mail Address * Parent/Guardian’s Name Parent/Guardian’s Occupation Work Phone Cell Phone E-mail Address How did you hear about Bannockburn Nursery School? * Has your child ever been in a school or day care program before? * - Select -YesNo If yes, which one? Briefly indicate why you are changing programs. In order to plan for the most successful school experience for your child, the staff needs to know if your child has been treated for, or you suspect, that your child has any special emotional, physical, or behavioral needs. Examples include, but are not limited to attention deficit, sensory integration problems, severe allergies, impaired senses, and physical limitations. Please specify here any that apply to your child whether they have been diagnosed by a professional or not (use back of application if additional space is needed). Special Needs * Class Placement Request Please indicate your class preference. In the event your preference cannot be accommodated, a school representative will contact you to discuss alternate class placement where possible. Child Placement * Sprouts, 2-&3-year olds – (Age 2 by Sept. 1) Saplings, 3- & 4-year olds – (Age 3 by Sept. 1) Mighty Oaks, 4- & 5-year olds – (Age 4 by Sept. 1) Priorities for Acceptance Applications received by DECEMBER 1st, which meet any of the following criteria (listed in order of priority), are given preferential consideration for admission to the school or the wait list. Please check any of the following that apply to your child: Priorities for Acceptance Members applying for a child who is already enrolled and children of BNS employees. Family applying for a child who will be attending concurrently with a sibling who is already enrolled. Family who has had children previously enrolled in the school. Family currently resides within the Bannockburn community or the Bannockburn Elementary School district. Parents/Guardians who attended BNS as children. List years attended: Refund Policy If I withdraw my child by March 1st, the $500 deposit will be refunded. After March 1st any deposit and/or tuition is forfeited. If I voluntarily decide to withdraw my child from the School after the commencement of the school year I must provide the School with notice of the intention to withdraw at least four (4) weeks before my child’s departure. Such notice shall be provided in writing to the President of the Board of Directors. All pre-paid tuition and fees will be forfeited and I will remain responsible for payment of all tuition and related fees until the vacancy caused by my child’s departure is filled or until the end of the school year, whichever occurs first. Voluntary departure shall not include any withdrawal that occurs based on a mutual agreement between School staff and/or the Board of Directors that the child’s continued enrollment in the School is not in the best interest of the child, the family, and/or the School, nor shall the term include withdrawals pursuant to Section XII of the bylaws. (A copy of the by-laws is available from the School Office). Parent/Guardian signature * Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Application Fee and Deposit In addtion to the $60 application fee would you like to make your $500 deposit now? * Yes, I'll make my $500 deposit now No, please invoice me, I'd like to make my $500 deposit at a later date Amount due now - $00.(Total cost includes a 3% credit card service fee) Credit Card Information Issuer - None -VisaMasterCardAmerican ExpressJCBDiscoverDiners Club Credit card number Secure code Expiry date Month 010203040506070809101112 Year 202120222023202420252026202720282029 Submit
