St. Michael Catholic School 2022-2023 Stay and Play Registration

St. Michael Catholic School 2022-2023 Stay and Play Registration
Student Name *

First Name Middle Name Last Name
Gender *

Male Female
Date of Birth *

Month Day Year
Date
Age on the date of registration *
Child resides with *

Programs

Stay and Play 11:00 a.m. - 5:30 p.m.
- 2 Days $88
- 3 Days $110
- 5 Days $162
- Drop in - $47 per day
Early Pick Up Stay and Play 11:00 a.m. - 2:30 p.m.
- 2 Days $45
- 3 Days $56
- 5 Days $82
- Drop in - $27 per day
Stay and Play payments are due weekly and at the beginning of the week. Lunch and afternoon snack is included in the Stay and Play fee.
Program Registering For: *

Stay and Play 11:00 a.m. - 5:30 p.m. Early Pick Up Stay and Play 11:00 a.m. - 2:30 p.m.
Days Attending

Monday Tuesday Wednesday Thursday Friday

Father
Name *

First Name Last Name
Home Phone
Work Phone
Type a question

Type option 1 Type option 2 Type option 3 Type option 4
Address *

Street Address

Street Address Line 2

City State

Zip Code
Mobile Phone *
Email *
example@example.com
Mother
Name *

First Name Last Name
Home Phone
Work Phone
Address: *

Street Address

Street Address Line 2

City State

Zip Code
Mobile Phone *
Email *
example@example.com
Emergency Contacts (other than parents)
Contact 1 Name *

First Name Last Name
Phone *
Relationship to Student *
Contact 2 Name *

First Name Last Name
Phone *
Relationship to Student *
People Authorized to Pick Up My Child: *
Health Information
Doctor *
Clinic *
Phone *
Dentist *
Clinic *
Phone *
Dietary or Medical Needs
Other Medical, Educational, Behavioral Concerns/Diagnosis
Registration of the student is only complete when the Registration Form is filled out in its entirety, signed, and submitted.
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
Email *
example@example.com

St. Michael Catholic School 2022-23 Stay and Play Tuition Agreement
Responsible Billing Party
Name *

First Name Last Name
Home Phone
Mobile Phone *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Email *
example@example.com
Relationship to Student *
Stay and Play Tuition

Stay and Play 11:00 a.m. - 5:30 p.m.
- 2 Days $88 - Prepaid and Due Weekly
- 3 Days $110 - Prepaid and Due Weekly
- 5 Days $162 - Prepaid and Due Weekly
- Drop in - $47 per day
Early Pick Up Stay and Play 11:00 a.m. - 2:30 p.m.
- 2 Days $45 - Prepaid and Due Weekly
- 3 Days $56 - Prepaid and Due Weekly
- 5 Days $82 - Prepaid and Due Weekly
- Drop in - $27 per day
Weekly Payment Option - Due the 1st day of each week.
Payment Method *

Weekly EFT
TUITION ACCOUNTS MUST BE KEPT CURRENT AND PAID-IN-FULL BY THE FIRST DAY OF THE WEEK
- All tuition payments are non-refundable.
- Checks should be payable to "St. Michael Catholic School."
- All tuition payments are to be submitted according to the dates outlined in this contract and the options selected/agreed to by the responsible parties. Payment is expected for all charges incurred whether your child attends Stay and Play on their scheduled day(s) or not.
- Past-due tuition is automatically subject to a $25 late fee that is not applied to tuition. Past-due payments are not considered received unless the late fee accompanies the payment.
- Payments received after 6:00 p.m. on the first day of each week is considered past due.
- Any payment returned for insufficient funds will be subject to a $30 fee and requires immediate redemption by the family.
- No account will be allowed to be more than one week past due. Your child's spot will be held for one week. If the account is not paid in full at the end of the week, your family will be dismissed from St. Michael Catholic Preschool and past due payments will be expected within 30 days.
By signing this Tuition Agreement, I understand that I am responsible for Stay and Play Tuition. *

Parent/Guardian Signature Clear
Date *

Month Day Year
Date
Should be Empty:

St. Michael Catholic School 2022-2023 Stay and Play Registration

Father

Mother

Emergency Contacts (other than parents)

Health Information

St. Michael Catholic School 2022-23 Stay and Play Tuition Agreement

Responsible Billing Party