ESage School Year 2019/20 Registration
Email address *
Child's Last Name *
Your answer
Child's First Name *
Your answer
Grade (2019/20) *
Your answer
Gender *
Date of Birth *
Your answer
Address (#, street address, zip) *
Your answer
1st Parent/Guardian Last Name *
Your answer
1st Parent/Guardian First Name *
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Email Address *
Your answer
Home Address (if different from child's)
Your answer
Employer
Your answer
Would you be willing to host an ESage field trip/learning opportunity through your workplace?
Your answer
2nd Parent/Guardian Last Name
Your answer
2nd Parent/Guardian First Name
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
Employer
Your answer
Would you be willing to host an ESage field trip/learning opportunity through your workplace?
Your answer
Emergency Contacts/Persons authorized to pick-up (In addition to parents)
Name, Phone number, relationship
Name, Phone Number, Relationship *
Your answer
Name, Phone Number, Relationship
Your answer
Please check if you do NOT want your child's photos to appear on the ESage blog or other promotional materials used by Sage International School.
Parent/Legal Guardian Signature
Your answer
Date
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Has your child had any serious or severe illnesses or accidents in the last 3 years?
Your answer
Does your child take any medication during the day? If yes, Medication Release Form is required. *
Your answer
Allergies? *
Your answer
Does your child have asthma? *
Your answer
Are there any concerns about your child's health or development that we need to be aware of? *
Your answer
I hereby give permission to Sage International School and its employees to release any and all of the above health history to any medical personnel rendering emergency medical aid or treatment to my child. I give consent to have my child receive emergency first aid by facility staff, and if necessary to be transported by ambulance to receive emergency care.
Parent/Legal Guardian Signature *
Your answer
Date *
MM
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DD
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YYYY
*** UPDATED*** ESage Payment Policy
* * * THESE HAVE BEEN UPDATED SINCE SUMMER 2019. Please read in its entirety. * * *

The following terms and conditions apply for all ESage accounts. Please read and sign below.

The online billing management software we use is Procare. Your account can be accessed by setting up an account at www.myprocare.com . Your login is the email you supplied to ESage on this enrollment form. Please use your account to view your statements, make a one time payment, or set up autopay.

Payment/Termination of Services:
Invoices will be sent out on or before the 25th of every month. Monthly invoices will reflect schedule changes from the previous month, days added or subtracted from the original schedule, along with charges for the upcoming month based on current information. For example: August 25th invoice will show schedule changes, additions or subtractions only, made from end of July or in August up to the invoice date and charges for the upcoming month, September 1st-30th. We will send one (1) monthly invoice in addition to one (1) year end invoice. Please keep these records, additional copies of invoices will not be provided.

Tuition must be paid in full by the 5th of each month. If your account is overdue by more than five (5) business days, you will incur a $5 late fee per day. Any payments received after the late fee is assessed will be applied to the late fee first and then to the tuition. If your payment is two(2) weeks past due your child will not be allowed to participate in the ESage program until the balance is paid.

Please note: Credits for schedule requests and any payment that is not made through Procare may take up to 48 business hours to be processed before being reflected on your account.

Payment Options:
- Check or Cash: Payable to ESage and dropped in the gray payment box located in the ESage room or front desk at the Main Building
- Bank Draft via online Procare Account
- Credit/Debit Cards (3.75% fee) via online Procare Account
**** If you are paying through bill pay please write ESage in the memo line

Sibling Discount:
10% off each sibling in the family that attends ESage together on the same day.

Regular School Year Schedule/ Change Policy:
This paragraph applies to Mon-Thur after school and Friday all day during the regular school year. This is NOT for School Breaks. For the School Break policy, please see below.

You can either choose to have a regular, ongoing weekly schedule or choose to be on a drop-in only status. Please know that drop-in is based on availability. Any changes to your current schedule must be submitted via the Schedule Request Form ONE WEEK prior to the date of the change to receive a credit. If your child is enrolled as a drop-in, and you would like to add days, the Schedule Request form will need to be submitted 48 hours prior. Drop-ins are subject to availabilty. If you are a drop-in schedule only tuition will be due at the time of service.

School Break Schedule/Change Policy:
School break registration will open 6 weeks before break and will close 2 WEEKS prior to break. You may make adjustments to your child’s schedule up until registration closes. Once registration has closed we will not be able make any changes to your child’s schedule or provide any credits and you will be billed on what you have signed up for.

After Hours Policy:
Employees are scheduled until 6:00pm. Late pick-ups require employees to stay past their scheduled hours. Please respect their time and avoid late pick-ups fees by arranging to have your child picked up no later than 6:00pm. If your child is picked up later than 6:00 the following fees apply, 6:00pm to 6:15 $3.00/minute/child, 6:16pm to 6:30pm. $5.00/minute/child. Charges apply, per child, each day a parent arrives late. Excessive late pick-ups or failure to pay late fees will result in dismissal from the ESage program.

I have read and understand the terms and conditions of the ESage Payment Policy and agree to abide by all the above stated terms. I also understand that I, the undersigned, am the person solely responsible for payment of my account regardless of any other parties involved (i.e. co-payer, ICCP, etc.).
Parent/Legal Guardian Signature *
Your answer
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