ACCDC Registration Form

Student Name*

Gender*

Nickname

Date of Birth*

Current age:*

Mother's Name:

Father's Name

Mother's Cell Phone

Father's Cell Phone

Home Phone

Primary phone number to be used

Primary email address to be used

Address

Street Address Address Line 2 City State ZIP Code

Current Church Member **Active Members of Asbury United Methodist Church receive 10% off monthly tuition & $25 off registration fee*

Yes
No

Choose which program your child would attend.*

Full Day Preschool: Infant-Pre K, Mon. to Fri., 7:30 am to 5:30 pm, Monthly Tuition - $645, Infant $685, Bi-Annual Material fee $75 (due in Sept & Jan.), Annual Registration Fee $175.
5 Day Preschool: Infant-Pre K, Mon. to Fri., 8:30 am to 3:00 pm, Monthly Tuition - $545, with early drop off option at 8:00 am - $590, Infant $585 with 8 am early drop off $630, Bi-Annual Material fee $75 (due in Sept & Jan.), Annual Registration Fee $175.
3 Day Preschool: Infant-Pre K, Mon-Wed-Fri, 8:30 am to 3:00 pm, Monthly Tuition - $330, with early drop off option at 8:00 am - $360, Bi Annual Material fee $65 (due in Sept & Jan.), Annual Registration Fee $175.
2 Day Preschool: Infant-Pre K, Tues-Thurs, 8:30 am to 3:00 pm, Monthly Tuition - $220, with early drop off option at 8:00 am - $245, Bi Annual Material fee $55 (due in Sept & Jan.), Annual Registration Fee $175.

Transitional Kindergarten will be offered if there is a need and sufficient number of students to sustain a class. This class if offered for children that are eligible to go to Kindergarten; however, the parents have decided to postpone for a year. Some children benefit from the additional time to socially mature and develop skills necessary for Kindergarten. Please indicate below if you are interested in your child attending a Transitional Kindergarten class.*

Yes
No

The two sections below are to be completed at the ACCDC office. Effective January 2, 2018 there will be a $10 monthly fee for payment made with a credit or debit card.

To guarantee your child a place in ACCDC for the school year 2018/2019, the following are required:

1. the NON-REFUNDABLE registration fee of $175
2. payment of half of August tuition is due by February 16, 2018.
3. acceptance of Registration Agreement (below)

Registration Agreement: It is agreed that tuition will be paid on the first of each month and if not paid by the 10th of each month a $25 late fee will be charged. The material fees will be paid in September and January before the 10th of the month. I understand that all fees are non-refundable and non-transferable should my child not participate the program which we have registered to attend. (Parent's Signature below)