Application for Enrichment Enrollment
Weeks of March 2, March 9, March 16, March 23 and March 30. Make up day = Week of April 6

****** You must provide a $82.50 non-refundable tuition fee per class within 5 business days for this Registration form to be valid. More information at the bottom of this form. Submit check for enrichment tuition by Thursday, February 13 at 12:30 PM ******
Email *
Child's First Name *
Child's Last Name *
Which enrichment class would you like to enroll your child in? *
Required
Which class is your child in? *
Name of Parent/Guardian #1 *
Email of Parent/Guardian #1 *
Name of Parent/Guardian #2
Email of Parent/Guardian #2
Who else will pickup your child?
Cell Phone *
Emergency Contact Name *
Emergency Contact Phone *
Does your child have any food allergies? *
Is there any present condition that the school should be aware of in the planning of your child's program (i.e. visual, hearing, allergies, medication, early intervention, speech and/or occupational therapy services, etc)? Please explain.
Digital Signature of Parent/Guardian
PLEASE READ:
By digitally signing this document, the signee has agreed to provide a non-refundable $82.50 tuition fee per class to save their child's spot. Please provide a check in the payment box or send to our PO BOX: Tri-Village Nursery School, P.O. Box 103, Delmar, NY 12054. In your check notes, please write the name of the child and which Enrichments you chose. The check must be provided within 5 business days to hold your spot. Checks sent to our PO BOX must be stamped within the 5 business day period. Checks need to be provided no later then Thursday, February 13 at 12:30 PM

Classes are capped at eight students; if more than eight students register, we will hold a lottery on Friday, February 14th and create a wait list as needed. Checks will not be cashed until your registration and acceptance of the spot are confirmed.
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