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Phone:
630-377-8794
Fax:
630-578-0948
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Young Leaders Bilingual Academy
2010/2011 Application
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Class Calendar: August 30 2010-May 27, 2011
No classes September 3 (Teacher Institute), September 6 (Labor Day),
October 8 (School Improvement), October 11 (Columbus Day),
November 22-November 26 (Thanksgiving Vacation),
December 20-January 2 (Christmas Vacation),
January 14 (Teacher's Work Day) January 17 (Martin Luther King),
February 21 (Presidents' Day) , February 25 (Teacher Institute),
March 28-April 1 (Spring Break) , April 22 (School Improvement Day)
PreK 3 Program - 3 days/week or 5 days/week (must be 3 yrs by August 23)
3 days; Tuesday-Thursday Thursday 9:00-1:00
5 days; Monday -Friday 9:00-1:00
Registration fee: $200
Yearly Tuition for 3 day program: $3024
Yearly Tuition for 5 day program: $3840
PreK 4 Program (must be 4 years by August 23)
3 days; Tuesday-Thursday Thursday 9:00-1:00
5 days; Monday -Friday 9:00-1:00
Registration fee: $200
Yearly Tuition for 3 day program: $3024
Yearly Tuition for 5 day program: $3840
Kindergarten Program (must be 5 years by August 23)
Monday - Friday 9:00 a.m. - 1:00 p.m.
Registration Fee: $200
Yearly Tuition: $3840
1st grade program
Monday - Friday 9:00 a.m.-1:00 p.m.
Registration Fee: $200
Yearly Tuition: $4190
_______ My child will bring their lunch from home.
_______I would like my child to recieve lunch at school ($375 for the year.)
Our organic lunches contain 100% natural ingredients with no additives,
preservatives, or chemicals of any kind.
Upon submission of this packet please provide:
· Student’s original birth certificate or copy
· Proof of immunization or exemption form immunization
· Completed enrollment form and registration fee
Legal Name of Student:________________________________________________DOB______________
Last School Students attended:________________________________________grade completed:___
Social Security Number:________________________________________________
Student Address:__________________________________City:_________________Zip:_____________
Gender (circle): Male Female
Name of Parent(s):___________________________________________________________________
Home Phone:______________________________
Cell Phone #1:_____________________________
Cell Phone # 2:_____________________________
Emergency Contact Person:__________________________
Relationship to Student:_________________
Emergency Contact Home Phone:_____________________
Emergency Contact Cell Phone:_______________________
Students Health Information
Physician:___________________________
Physician Address:_____________________________________
Physician Phone:__________________
Dentist :___________________________
Dentist Address:_______________________________________Dentist Phone:____________________
Vision
Known eye condition (other than corrective lenses)_____
Wears glasses _____ Worn at all times _____
Wears contact lenses _____ Worn at all times _____
Hearing
Known hearing problem _____ Uses hearing aid _____ Has tubes in ears _____
Allergies
Food _____ Environment _____ Medicine _____
Comments: _________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Student has the following conditions:
Does medication need to be administered during school hours? Yes No
Please provide a signed Physician’s Authorization for Medication in School form
Condition Medication prescribed by doctor Dosage Times to administer
_____ Asthma ___________________________ __________ ________________
_____ Epilepsy ___________________________ __________ ________________
_____ Fainting Spells ___________________________ __________ ________________
_____ Diabetes ___________________________ __________ ________________
Young Leaders General Permission Slip
As part of the education process at Young Leaders Academy, students will be participating in out-of-class
projects, going to museums, conferences, galleries, convocations, doing science field observations and engaging in many other related activities.
This permission slip is for all such trips that take place during the regularly scheduled academic day and that are part of the Young Leaders curriculum.
By signing this form you are giving your general permission for your child to engage in those activities that occur as part of the experiential education component of Young Leaders.
_______________________________________________________________________________
Student’s Name
_______________________________________________________________________________
Parent’s Name
_______________________________________________________________________________
Parent Signature Date
Tuition:
A non refundable registration and material fee is due upon registration.
Registration Fee:
PreK 3: $200
PreK4: $200
K5 : $200
Please make your check payable to Language Leaders.
Autopay (Tuition is broken down into 10 monthly payments of $400/student ) I would like to sign up for Autopay and have my credit card charged on the 1st of each month. ________________________________________
Signature
Visa Cardholder Name:____________________________________
Card Number:_________________________________________________________exp date:_______
Signature:____________________________________________________________Amount:_________ |
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