Summit Academy Preschool Application
Summit Academy Draper Campus & Summit Academy Bluffdale Campus
Establishing learning and instilling positive behavior for future sucess
Thank you for your interest in Summit Academy Preschool. As you know, the first few years of a child's education sets the groundwork for academic success. At Summit Academy Preschool, we have passionate teachers who cultivate a warm and caring learning environment. Our preschool curriculum will provide a solid foundation for your child in Reading, Writing, Math, Science, Music, Critical Thinking, Physical Education, Art, Social Skills, and Learning Behavior.

We help students recognize, look for, and use logical thinking in order to find connections in their environment. Summit Academy Preschool stands out because our highly trained and qualified teachers identify and address individual learning styles. This approach enables the teachers to present the academic program in dynamic and meaningful ways.

To enroll your child into Summit Academy Preschool, we encourage you to apply early as we enroll on a first come, first serve basis. The non-refundable registration fee is $50.00

Summit Academy Preschool accepts preschoolers who are between the ages of 3 and 5 years of age and have self reliant bathrooms skills.

*It is important to note that entrance into the Preschool at Summit Academy does not guarantee entrance into the elementary school. Summit Academy Elementary has a separate entrance process.

Student Information
Student First Name *
Your answer
Student Last Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Gender *
Parent Contact Information
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Daytime Phone Number *
Your answer
Email Address: *
Your answer
Additional Phone Number
Your answer
Mailing Address *
Your answer
City *
Your answer
Zip *
Your answer
Emergency Contact Information
(Other than above parent contact)

I give permission for the following people to pick up my child from school.

#1 Emergency Contact *
First Name
Your answer
#1 Emergency Contact *
Last Name
Your answer
#1 Emergency Contact *
Phone Number
Your answer
#1 Emergency Contact
Additional Phone Number
Your answer
#2 Emergency Contact *
First Name
Your answer
#2 Emergency Contact *
Last Name
Your answer
#2 Emergency Contact *
Phone Number
Your answer
#2 Emergency Contact
Additional Phone Number
Your answer
Additional Person who can pick up my child
Your answer
Additional Person who can pick up my child
Your answer
Does your child have any known allergies? *
If yes, please provide emergency treatment instructions
Your answer
Does your child have any special physical or mental needs? *
If yes, please contact the Coordinator regarding these needs.
Does this student have a sibling attending? *
Required
Class Tuition and Location
Select Class of your choice
Extended (11:30-1:00) --- 4 Yr Old/Kindergarten Students Only *
One Day $100, Two Days $115, Three Days $130, Four Days $145, Five Days $160
Required
Enrichment (11:30-3:00) ---- Kindergarten Students Only *
One Day $215, Two Days $240, Three Days $265, Four Days $290, Five Days $315
Required
Class Times
A.M. Classes, Drop Off 8:30-8:40 A.M. Pick Up 11:30
P.M. Classes, Drop Off 12:10-12:20 P.M. Pick Up 3:10
Final Step to complete your Preschool application
1. Review and sign the Consent/Waiver & Agreements forms:

https://drive.google.com/file/d/1uUfFmlZOpAx6b2znyVMNmy6R7TtG8huj/view?usp=sharing

2. Copy of Students Immunization Record or Exemption Form emailed preschool@2summit.org or faxed to 801-572-9875.

3. $50 Registration fee submitted online at https://secureinstantpayments.com/sip/?ID=16007

Forms can also be submitted along with a $50.00 registration fee to the elementary office at:

Summit Academy Draper Campus,
1285 East 13200 South, Draper, UT 84020
OR
Summit Academy Independence Campus,
15327 South Noell Nelson Dr, Bluffdale, UT 84065
OR
Summit Academy Bluffdale Campus,
1940 West 14400 South, Bluffdale ,UT 84065

ENROLLMENT NOT COMPLETE UNTIL ALL ABOVE ITEMS ARE RECEIVED.
* Tuition is due by the first (1st) of each month; a late fee of $5.00 per day is then applied to your account after the fifth (5th). In the event that any balance is not paid as agreed, the undersigned agrees to pay a collection fee equal to 40% of the unpaid balance. In the event of a collection action or lawsuit is commenced, the undersigned further agrees to pay cost, services charges, court cost and reasonable attorney's fees.
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