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Phone:
630-377-8794
Fax:
630-578-0948 

 

Please mail your application to:
 
401 W. State St.
Geneva, IL.
60134

 

Young Leaders Bilingual Academy
2010/2011 Application




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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