Enrollment Form

My Time Kids Academy- Spicewood/ Rough Hollow

Director: Lorie Baez/ Kelsey Link 3108 Bee Creek Rd Spicewood, Tx 78669
REGISTRATION SUBJECT TO AVAILABILITY

Many of our classes at the Bee Cave/ 620 campus have reached capacity. Upon receipt of this form, we will reach out to confirm placement. Please allow 1 full business day for us to reach out.
Summer Camp Enrollment Form

This form is intended for 2024 Summer Camp at the Spicewood/ Rough Hollow location only. An enrollment form is needed PER child. Please fill out one form per child attending Camp. Sibling discounts will be applied to the youngest child's tuition. Confirmations of placement will be sent via email provided -within 5 business days of submission.
ALERT Regarding Enrollment~

Many of the classes at our campus have reached CAPACITY. Upon receipt of this form, administration will reach out to confirm placement. As of June 9th, AfterCare is not available for any age group for Session 2 (July 10-14).
Anticipated First Day of Attendance (use Session Dates Above):*

MonthDayYear
Date
Child's Date of Birth*

MonthDayYear
Date
Age as of June 1, 2024 (years and months)*
EX: 3 years 4 months
Child's Name*

First NameLast Name
Name your child goes by: *
Gender*

FemaleMale
Child lives with:*

Both parents/ guardiansMotherFatherGuardian
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number- **WE WILL CALL THIS NUMBER FIRST***
Email- must be one that you check frequently and adult can be contacted by*
example@example.com
Custody documents submitted to MTKA Administration?*

Yes, I will submit these PRIOR to my child's first day.Not applicable.Other- I will contact the MTKA Director to discuss.
ALERT Regarding Enrollment~

Many of the classes at our campus have reached CAPACITY. Upon receipt of this form, administration will reach out to confirm placement. As of June 9th, AfterCare is not available for any age group for Session 2 (July 10-14).

TUITION & FEES~ Summer 2024

**Please Note**
Upon registration for Summer Camp, there are no make-ups or refunds.
Camp session transfers will be honored based on availability and enrollment numbers.

New Families: Deposit due at registration.
Current MTKA Families: Deposit due April 22, 2024.
Full Summer- 8 week camp- Tuition will be billed by the session.
Sibling Discount: 1st child full price, siblings 10% tuition only*
Payment in full discount: 3% ~applies to Full Summer 8 week program attendees only. *Discounts do not compound*

All Summer Fun! 8 Week Program: June 3- August 2
*prices in chart are MONTHLY tuition rates*

Attendance	9a- 2p	8:30a- 2p	9a-5:00p	8:30a-5:00p
2 Days (T/Th)	$844	$910	$1,193	$1,204
3 Days (MWF)	$1,076	$1,197	$1,496	$1,543
5 Days (M-F)	$1,528	$1,603	$2,007	$2,042

Secure 8 week Summer enrollment by paying the following:
8 week program: $425 deposit (non-refundable). Deposit consists of combined activity/supply fees, facility/ grounds fee, and summer administrative fees.
Current MTKA Families:
- Deposit due April 22, 2024
- Session 1 due June 1st
- Session 2 due July 1st
New Families:
- Deposit due at enrollment
- Session 1 due April 1st
- Session 2 due June 1st
Activity/ Supply Fee: $225 (paid in deposit)
Facility/ Grounds Fee: $100 full summer program (paid in deposit)
Holiday Break: July 1-5

Single Session Program:
*prices in chart are per session tuition rates*
Session 1: June 3- June 28 Session 2: July 8-Aug. 2

Attendance	9a- 2p	8:30a- 2p	9a- 5:00p	8:30a- 5:00p
2 Days (T/Th)	$844	$910	$1,193	$1,204
3 Days (MWF)	$1,076	$1,197	$1,496	$1,543
5 Days (M-F)	$1,528	$1,603	$2,007	$2,042

$350 deposit (non-refundable). Deposit consists of combined activity/supply fees, facility/ grounds fee and summer administrative fees.

Secure Single Session Summer enrollment by paying the following:

Current MTKA Families:
- Deposit due April 22, 2024
- Remaining balance due May 15, 2024
New Families: Single Sessions 1 & 2 tuition and fees will be due at time of registration.
Activity/ Supply Fee: $150/ session (paid in deposit)
Facility/ Grounds Fee: $50/ session (paid in deposit)

Wacky Week Aug.5-9: reserved for Fall 2024 students only
*Wacky Week 5-day camp available to students enrolled in the 2024-2025 school year at MTKA. Limited space available, admin approval required

Wacky Week	9a-2p	8:30a- 2p	9a- 5:00p	8:30a- 5:00p
5 Days	$385/ week	$415/ week	$515/ week	$530/week

Secure Wacky Week enrollment by paying the following:
Tuition will be due July 14, 2024
Fees above include supply/ activity fee for the week

ALERT Regarding Enrollment~

Many of the classes at our campus have reached CAPACITY. Upon receipt of this form, administration will reach out to confirm placement. As of June 9th, AfterCare is not available for any age group for Session 2 (July 10-14).
Program Attendance Options:*

8 week SUMMER CAMP (June 5 - Aug. 2 *Holiday break July 1-5)Session 1: June 3- June 28 (4 weeks)Session 2: July 8- Aug. 2 (4 weeks)Wacky Week: Aug.5-9 (5 days, limited availability, admin approval required)
Days that your child will attend our program:*

2 day program: T/Th3 day program: M/W/F5 day program: M-F
Attendance Time Options: (choose one) Please note: Extended Care ends at 5pm*

9:00am-2:00pm: Regular Program Hours (5hrs/ day)9:00am- 5:00pm: Regular Program with After-Care (8 hrs/ day) *limited availability8:30am- 2:00pm: Early drop off (5.5 hrs/ day) *limited availability8:30am- 5:00pm: FULL day (8.5 hrs/ day) *limited availability
Parent/ Guardian 1*

First NameLast Name
Relationship to Child:*

MotherFatherGuardian
Phone Number- Parent/ Guardian 1*
Email- Parent/ Guardian 1*
list an email checked frequently
Address if different from address listed for child

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian 2 *

First NameLast Name
Relationship to Child:*

MotherFatherGuardian
Phone Number- Parent/ Guardian 2: Number listed MUST be different that Parent/ Guardian 1*
Email- Parent/ Guardian 2*
list an email checked frequently
Address if different from address listed for child

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Important information regarding your child:
Does your child have any medically diagnosed allergies?*

Yes- I understand that I must submit an Allergy Action Plan signed by physician.No
Does this medically diagnosed allergy require an Epi-Pen?*

Yes, I understand that I must provide the school with an Epi-Pen for my child.No, this allergy does NOT require an Epi-Pen.My child does NOT have a medically diagnosed allergy.
Please include details about the medically diagnosed allergies listed above:
ex: Food/ Insect/ Environmental... Reaction type: ingestion/ contact/ proximity
Has your child experienced a significant life event that continues to affect their life? If Yes, please explain. If No, please type NA.*
Please list any serious illness/ injury or recent hospitalizations within the last 12 months.*
If no, please type NA
MTKA students do not participate in swimming. Supervised water activities at MTKA are: water sprinklers, water slide, water table, splash/ wading pool, water hose for gardening.*

I AGREE to the MTKA supervised water activities for my child.I DO NOT want my child to participate in the supervised water activities.
Special Care Needs (accompanied by medical professional's recommendations):*

Limitations/ Restrictions on activitiesReasonable Accommodations or ModificationsAdaptive equipment neededSpecific symptoms or indications of complications due to medical/ physical needThis portion does NOT apply to my child.
Child's Health: Please share any special needs that your child may have such as: food intolerance/ sensitivities, environmental allergies, existing illness, any medications prescribed for long-term use, cognitive or physical concerns/ disabilities, and/ or any other important information regarding your child’s well-being. Sharing this information allows us to provide the best possible school environment for your child. *
Varicella (Chickenpox) vaccine is not required if your child has had the Chickenpox disease. If your child has had Chickenpox, please retype and complete the following statement in the field below: MY CHILD HAD VARICELLA DISEASE (CHICKENPOX) ON OR ABOUT(DATE) AND DOES NOT NEED VARICELLA VACCINE.*
Please enter Varicella statement listed above, or type: My child HAS NOT had Varicella Disease as of today.
By filling in your name below, you are confirming the statement you typed above regarding Varicella Disease (Chickenpox).*

First NameLast Name
Emergency Contact/ Authorized To Pick Up

Please list an ADULT that is permitted to pick up your child in the event you can not be reached or unable to pick up your child from school. This person must have a local address.
Emergency Contact #1... permitted to pick up child*

First NameLast Name
Emergency Contact #1- Relationship to child:*

RelativeNanny/ BabysitterNeighborFamily Friend
Emergency Contact- Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact- Phone Number*
Emergency Contact #2... permitted to pick up child*

First NameLast Name
Emergency Contact #2- Relationship to child:*

RelativeNanny/ BabysitterNeighborFamily Friend
Emergency Contact #2- Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact #2- Phone Number*
My Time Kids Academy Withdrawal/ Program Drop Policy
- The Enrollment Fee is non-refundable, noted at time of enrollment.
- Supply/ Activity Fee is non-refundable, noted at time of enrollment.
- Tuition refunds will not be granted without proper 30 day written notice.
- Tuition is non-refundable due to closure or quarantine initiated by state officials, CDC & Health officials, or MTKA administration due to COVID-19 or other viruses/disease.
- Unpaid fees by due date will result in forfeit of registration.
Please Note: Upon registration & payment for Summer Camp, there are no make-ups or refunds. Session transfer requests will be honored based on availablity and enrollment numbers.
By typing your name below- you agree to adhere to the policy above:*

First NameLast Name
PAYMENT

Enrollment is finalized when payment is received.
- MTK uses BrightWheel for all payments, upon receipt of regsitration you will receive an invoice from BrightWheel. Please follow the steps in the confirmation email to complete payment.
- Current MTKA Families:
  - FULL SUMMER attendees:
    
    Deposit due April 22, 2024
    
    Session 1 due June 1st
    
    Session 2 due July 1st
  - SINGLE SESSION attendees:
    
    Deposit due April 22, 2024
    
    Remaining balance due May 15, 2024
- New Families:
  - FULL SUMMER attendees:
    
    Deposit due at enrollment
    
    Session 1 due April 1st
    
    Session 2 due June 1st
  - SINGLE SESSION attendees:
    
    tuition & fees due at time of enrollment
- Pay via BrightWheel ACH debit within 5 days
  Submit Summer Camp fees to My Time Kids via BrightWheel using ACH Debit. An invoice will be sent to you within 5 business days of submitting this form. Payment will be due the SAME DAY the invoice is sent. Early payments are welcomed.
- Deposits are NON-REFUNDABLE.
- Unpaid fees by due date will result in forfeit of registration.
- Registrations are date/ time stamped.
ACH Authorization: I hearby authorize BrightWheel, acting on behalf of My Time Kids Academy, to initiate withdraws in the form of electronic funds transfer from my financial institution as listed in my BrightWheel profile, for amounts owed to My Time Kids Academy, including, but not limited to: tuition & program fees, activity/ supply fees, and late fees. I understand that this authorization will remain in effect until My Time Kids Academy has received written notification of my child withdrawing from the programs provided by My Time Kids Academy or alternative payment arrangements such as payment in full, have been approved by MTKA administration.
By typing my name below, I certify that all information submitted in this document is VALID for this child.

First NameLast Name
Should be Empty:

My Time Kids Academy- Spicewood/ Rough Hollow

REGISTRATION SUBJECT TO AVAILABILITY

Summer Camp Enrollment Form

ALERT Regarding Enrollment~

ALERT Regarding Enrollment~

ALERT Regarding Enrollment~

Important information regarding your child:

Emergency Contact/ Authorized To Pick Up