Online ENROLLMENT FORM FOR WEBSITE – CASTLE COUNTRY ACADEMICS

Name of Child

First

Last

Date of Birth

Boy / Girl

Boy
Girl

Parent/Guardians (financially responsible)

First

Last

Father’s Name

Mother’s Name

Street Address (where child's resides)

Street Number; Street Address: Zip Code: Name of Town: State:

Home Number

Cell Number

Email

Confirm Email

Current marital/legal status of the child’s parents

Name of Custodial Parent (if separated, divorced, or unmarried)

Parent/Guardian who does not live full-time with the child: Parent/Guardian Name

First

Last

Parent/Guardian who does not live full-time with the child:

First

Last

Adresss of Parent/Guardian who does not live full-time with the child: Address

Parent/Guarian who does not live full -time with the child: Home Phone

Parent/ Guardian who does not live full time with the child: Cell Phone

My child is enrolled in the program

TODDLER (starting age 18 months)
PRESCHOOL (starting age 24 months)
PRE-KINDERGARTEN AND T-KINDERGARTEN (starting age 36 months)

Will participate for (days). (M, T, W,TH,F), (M,W,F), (T,TH)

During the hours of: 7:00 to 5:30 or 8:30 to 3:30

Extended care needed: Time dropping and picking up child

/ or Payment

Toddler Weekly tuition totaling ($)

TODDLER (starting age 18 months) ● 5 days with Extended School Services (7:00 AM – 5:30 PM): $205.00 ● 5 days (8:30 AM – 3:30 PM) $185.00 ● 3 days with Extended School Services (7:00 AM – 5:30 PM): $160.00* ● 3 days (8:30 AM – 3:30 PM): $145.00* ● 2 days (8:30 AM – 3:30 PM): $110.00* ● 2 days with Extended School Services (7:00 AM – 5:30 PM): $130.00*

Preschool Weekly tuition totaling ($)

PRESCHOOL (starting age 24 months) ● 5 days with Extended School Services (7:00 AM – 5:30 PM): $195.00 ● 5 days (8:30 AM – 3:30 PM): $175.00 ● 3 days with Extended School Services (7:00 AM – 5:30 PM): $135.00

Pre-Kindergarten Weekly tuition totaling ($)

PRE-KINDERGARTEN AND T-KINDERGARTEN (starting age 36 months) ● 5 days with Extended School Services (7:00 AM – 5:30 PM): $190.00 ● 5 days (8:30 AM – 3:30 PM) $170.00 ● 3 days with Extended School Services (7:00 AM – 5:30 PM): $130.00* ● 3 days (8:30 AM – 3:30 PM): $125.00* ● 2 days (8:30 AM – 3:30 PM): $100.00* ● 2 days with Extended School Services (7:00 AM – 5:30 PM): $120.00*

I am initially aware that my child must be vaccinated to attend Castle Country Academics.

Yes (initials / aware)

Parent/Guardian Workplace and Phone Number

Parent/Guardian Signature

Parent/Guardian Name

First

Last

Single Line Text

Date

Registration Payment ($110.00) * NO REFUNDABLE: Cash, Check, Money Order, or Credit Card.

GDPR Agreement

I consent to having this website store my submitted information so they can respond to my inquiry.

Signature Here

Our Company

Useful Links

Company Info