SGBA Application 2023-2024

SUMMER GROVE BAPTIST ACADEMY
Date Registered

MonthDayYear
Date
Child's Name
Please select the program you are registering your child for:

8 Weeks - 12 Months/3 Day8 Weeks- 12 Months/5 Day18 Months/3 Day18 Months/5 Day2 Years/3 Day2 Years/5 Day3 Years/3 Day3 Years/5 Day4 Years/3 Day4 Years/5 DayBridge Program
Will your child be staying for Lunch Bunch on Tuesday, Wednesday, and Thursday from 12-2? (Lunch Bunch is offered at an additional price)

YesNo
Please select one:

MaleFemale
Address

Address

Street Address Line 2

City/Zip CodeState / Province

Postal / Zip Code
Child's Date of Birth

MonthDayYear
Date
Age on September 30th
(3 and 4 year olds MUST be potty trained)
Signature of person completing application

Clear
Father's Name
Occupation
Employer
Work Phone
Cell Phone
Best method of contacting parent
Email
example@example.com
Does this child live with this parent?

YesNo
If no, is this parent allowed to pick child up from school?

YesNo
Mother's Name
Occupation
Employer
Work Phone
Cell Phone
Email
example@example.com
Best method of contacting parent
Does this child live with this parent?

YesNo
If no, is this parent allowed to pick child up from school?

YesNo
Are you a member of a local church?

YesNo
Is there a court ordered custody agreement? If yes, please attach copy of agreement for our files.

YesNo
Names of other children in the family:
Name
Age
Name
Age
Name
Age
Name
Age
Please list people (other than parent) who have permission to pick your child up from school:
1.
Phone
Relationship to child
2.
Phone
Relationship to child
3.
Phone
Relationship to child
*Please make these persons aware that they must show an ID before child may leave. We will keep a copy of ID on file after the first pick-up.
Medical Information
Child's Name
Date

MonthDayYear
Date
Physician's Name
Phone #
Food Allergies
Seasonal Allergies
Physical Limitations
Hearing/Vision/Speech Difficulties
Any other special need/condition we should be aware of
'You must submit a copy of up to date immunization records before your child can attend preschool. **

Iunderstand the staff at Summer Grove Baptist Academy will exercise all reasonable care in supervising my child. However, the staff and Summer Grove Baptist Church cannot be held responsible for accidents which may occur. In the event that my child should need emergency medical care/treatment, and I nor my emergency contacts can be reached, I hereby give permission that 911 may be called and medical services rendered. I understand that I will be financially responsible for any medical care given. I also authorize my child to be transported by car or emergency vehicle if need be.
Parent Signature

Clear
Date

MonthDayYear
Date
Emergency Contact if parents cannot be reached:
Name
Phone
Relationship to child
Name
Phone
Relationship to child
SUMMER GROVE BAPTIST ACADEMY
3 Day Option (Tues., Wed., Thurs)

Registration Fee: $160 Monthly Tuition: $160

5 Day Option (Mon.-Fri) Registration Fee: $160 Monthly Tuition: $220

Bridge Program (Mon.-Fri) Registration Fee: $160 Monthly Tuition: $320

Tuition is due the first week of school. All other tuition payments are due on the FIRST day of the month. There will be no rate adjustments for absenteeism, holidays, or bad weather days. Pricing is subject to change.

*REGISTRATION FEE MUST ACCOMPANY APPLICATION FOR CHILD TO BE ENROLLED. THIS FEE IS NON-REFUNDABLE.

Lunch Bunch Extended Stay Program

Lunch Bunch is our extended stay program which allows children to stay later than regular preschool hours three days a week. The children bring their lunches and enjoy a time of free play in the classroom, on the playground, or in the gym. Children ages 2 and under will have a nap/rest time, and ages 3 and older will have the option to nap.

Children will stay until 2:00pm three days per week for an additional fee.

Lunch Bunch Days: Tues., Weds., Thurs. Monthly Tuition: $95/Month

Monthly sign up and payment is due at the first of the month. Your spot will not be reserved until your payment has been received.

** Bridge Students will stay for Lunch Bunch on Tues., Wed., and Thurs. Their lunch bunch fee is included in the monthly tuition.*

The drop-in rate is $30 a day. Lunch Bunch drop-in rate is $10 a day. Arrangements must be made at least one day in advance and payment must be made at time of reservation. Drop-ins are only taken if space allows.

*ALL FEES ARE SUBJECT TO CHANGE WITH A TWO-WEEK NOTICE
Should be Empty:

SUMMER GROVE BAPTIST ACADEMY

Medical Information

SUMMER GROVE BAPTIST ACADEMY