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Hubbliville Academy

New Student Application 2019 – 2020

Student Information
Child's Name
First Middle Last
Enrollment Date
Date Format: MM slash DD slash YYYY
Gender
- Male
- Female
Age
Date of Birth
Date Format: MM slash DD slash YYYY
Please choose program
- Pre-Primary (Age 2)
- Primary (Ages 3 – 5)
- Elementary (Grades 1 – 6)
Please choose Pre-Primary schedule
- Half Day (8:45am – 11:45am)
- Full Day (8:45am – 2:45pm)
- All Day (7:30am – 6:00pm)
Please choose Primary schedule
- Half Day (8:45am – 11:45am)
- Full Day (8:45am – 2:45pm)
- All Day (7:30am – 6:00pm)
Please choose Elementary schedule
- Full Day (8:45am – 2:45pm)
- All Day (7:30am – 6:00pm)
Drop off time
Pick up time
Toilet Training Fee
Is your child toilet-trained?
- Yes
- No
Toilet Training Fee: A $60 monthly fee will be added to the tuition of any child not fully toilet trained. A child that is fully toilet trained needs to be able to independently wipe themselves, be able to pull clothing up and down without adult assistance and must not be wearing diapers/pullups at naptime.
Discounts

Half Day & Full Day Discounts: The below discounts are only applicable on the Half Day and Full Day programs. No further discounts are applicable on the All Day programs which are already significantly discounted. Discounts may not be combined.
Please select the discount
- 5% discount for siblings (discount applied to tuition of youngest sibling)
- 5% discount for tuition paid in full by August 1, 2019
- 10% discount (per child) to military families or children of alumni
Applicant Information
Languages spoken at home
Home Address
Street Address City State / Province / Region ZIP / Postal Code
Does the applicant have previous Montessori School experience?
- Yes
- No
Name of previous school/daycare attended
School Address
Street Address City State / Province / Region ZIP / Postal Code
School Phone Number
Years Attended
Do we have permission to contact them?
- Yes
- No
Please describe in detail any allergies, medical conditions or physical disabilities the applicant has which the school should be aware of:
Has the applicant ever had any behavioral, psychological or educational evaluations?
- Yes
- No
If yes, what kind, when and by whom?

Please provide official copies of all reports to the school office.

--OR--

Upload the copies down below.

All evaluations help form a complete picture of a child’s learning style. Applications will not be considered complete until evaluation copies have been submitted.
Upload official copies of all reports here
Drop files here or
Family Information
Parent #1 Information
Relationship
Father
Step-Father
Guardian
Parent/Guardian 1 Name
Prefix First Last
Home Address
Same as child's

Street Address City State / Province / Region ZIP / Postal Code
Home Phone
Cell Phone
Email Address
Profession
Place of Employment
Address
Work Phone
Work Email
Skills you can share with the school community
Parent #2 Information
Relationship
Mother
Step-Mother
Guardian
Parent/Guardian 2 Name
Prefix First Last
Home Address
Same as child's

Street Address City State / Province / Region ZIP / Postal Code
Home Phone
Cell Phone
Email Address
Profession
Place of Employment
Address
Work Phone
Work Email
Skills you can share with the school community
Parent Marital Status
Married
Parents divorced/separated
Mother remarried
Father remarried
Single-parent household
Mother deceased
Father deceased
Applicant is living with
Both Parents
Father only
Mother only
School correspondence should be sent to
Both Parents
Father only
Mother only
Please indicate who is responsible for school related decisions
Both Parents
Father only
Mother only
Please indicate who is responsible for school bills
Both Parents
Father only
Mother only
Please indicate who has custody of the applicant
Both Parents
Father only
Mother only
Siblings
Name Age Grade School
Parent/Guardian Questionnaire
1. Please explain your expectations for your child’s schooling.
2. Please tell us why you think Paint Branch Montessori School is a good match for your child.
3. It is important for us to gain a thorough understanding of your child. Please describe your child as objectively as possible, including any special abilities or interests that your child has.
4. Please give us any additional information about your child that will foster his/her learning with us.
5. Please list the birth history of your child and explain if there were any complications.
6. Please tell us how you learned about Paint Branch Montessori School.
7. Do you have any helpful suggestions for our admission procedure?
PBMS Legal Policy & Fee Agreement

1. Trial Period: All children are subject to a six-week probationary period at their initial entry and at the beginning of each subsequent school year. The school reserves the right to ask any parent to withdraw their child at any time, for any reason, and at its complete discretion, and reserves the right to deny, cancel or suspend a child’s enrollment if deemed in the best interest of the child or the school.

2. Cooperative Undertaking: Education is recognized as a cooperative undertaking, a responsibility held jointly by the parents or guardians and the school. Upon signing this enrollment application, you agree along with the student to accept the full share of this responsibility, to maintain the academic standards and to fulfill your obligations as a cooperative member of the school community. These obligations include, but are not limited to, participating in school activities, supporting the school’s philosophy and policies, staying informed by reading school communications and communicating openly, constructively and in a civil manner with all school personnel. This contract may be cancelled and the student dismissed by the school in the event that the school determines that the parents or guardians are not supportive of the school’s goals and policies and that a mutually beneficial relationship is no longer tenable.

3. Application Fee: The non-refundable $100 application fee must to be submitted with this application.

4. Enrollment Fee: Upon completion of a successful student visit and notification from the school office, a $350 non-refundable enrollment fee must be submitted to reserve your child’s place for the 2019 – 2020 school year. Without the enrollment fee, your child is not guaranteed placement for the 2019 – 2020 school year.

5. Supply & Activity Fee: A $500 supply and activity fee for all students must be submitted by August 1, 2019. The supply and activity fee covers all field trips, admission prices, and in-house field trips as well as daily snacks and supplies. All Upper Elementary overnight trips will be billed separately.

6. Tuition Payment: The annual school tuition is paid in 10 monthly installments. The 10 tuition installments are due August 2019 through May 2020, on the first school day of each month.

7. Late Fee: There is a late fee of 5% of the amount due for payments more than 3 days late. Tuition payments 10 days or more in arrears, will result in the dismissal of your child from the program.

8. Return Check Fee: There is a $75 fee for payments returned due to insufficient funds. If a check is returned for insufficient funds, your future payments will need to be in the form of a bank check.

9. Financial Obligations: Contracts are to insure the stability of the school and are strictly enforced. Paint Branch Montessori School will not refund tuition or cancel unpaid obligations if the accepted student withdraws after the 6-week trial period. After the 6-week trial period, if you choose to withdraw your child before the school year is completed, you are still contractually responsible for the balance of the tuition payment and any legal fees incurred.

10. Collection Fees: In the event that the school undertakes collection procedures with respect to this contract, the parents/guardians will be responsible for and agree to pay the school all costs of collection, including but not limited to, court costs and attorneys’ fees.

11. Half Day & Full Day Early Arrival: Children not registered for All Day who arrive before 8:45am will be checked into Drop-in Before Care and will be charged the daily drop-in rate of $20. Payment is due, to the school office, on the day of service. There is a late fee of 5% of the amount due for payments more than 3 days late. Payments 10 days or more in arrears will result in the dismissal of your child from the program.

12. Half Day & Full Day Late Pick Up: Children picked up after 12:00pm (Half Day Program) or 3:00pm (Full Day Program) will be checked into Drop-in After Care and will be charged the daily drop-in rate of $45. Payment is due, to the school office, on the day of service. There is a late fee of 5% of the amount due for payments more than 3 days late. Payments 10 days or more in arrears will result in the dismissal of your child from the program.

13. All Day Early Arrival: All Day starts at 7:30am. Due to legal issues, staff cannot allow any student to enter the building before the opening time of 7:30am.

14. All Day Late Pick Up: All Day hours only extend to the closing time of 6:00pm. There is a fee of $5 per minute ($15 minimum) for any late pickups after 6:00pm. Payment is due, to the school office, upon receipt of the invoice. There is a late fee of 5% of the amount due for payments more than 3 days late. Payments 10 days or more in arrears will result in the dismissal of your child from the program. If your child is picked up late more than 3 times this will result in their dismissal from the After Care program.

15. Schedule Changes: Only one schedule change per school year is allowed with a $200 service fee. There is no credit for missed days. PBMS requires two-week advance notice for any schedule changes.

16. School Inclement Weather Hours: PBMS follows Montgomery County Public Schools (MCPS) inclement weather policy.

Please Note:

» There is no Before Care on late opening days

» There is no morning Half Day program on late opening days

» If MCPS opens 2 hours late, PBMS opens at 10:45am

» If MCPS closes 2 hours early, PBMS closes at 12:45pm

» There is no After Care on early dismissal days

17. Authorization for Releasing Children: For security reasons, your child will only be permitted to leave with the authorized people listed on the student release form, unless prior authorization is provided. Any individuals that staff are not acquainted with, will be required to show identification when coming to pick up your child.

18. Health Records: If your child has special needs or requirements, please notify the school office in writing. No student will be admitted to the school unless we have their complete Health Records.

19. Medication: PBMS Staff can administer medication only if we have the medication authorization form filled out by the guardian and doctor. Students with allergies, asthma or medical conditions must have this form completed and on file in the school office, before their first day of school.

20. Sick Child: If a child becomes ill at school with vomiting, fever, diarrhea, or shows any symptoms that we feel need attention, we expect the child to be picked up immediately. Children can only return to school when they have been symptom free for 24 hours.

21. Non-discrimination: PBMS does not discriminate on the basis of race, color, religion, or national origin in the admission of students, or employment of faculty and administrative staff.

22. Falsified Information: PBMS reserves the right to withdraw acceptance or dismiss the applicant from the school in the case that incomplete or incorrect information has been provided. The information collected by the school is confidential and is intended only for PBMS purposes.

23. Hold Harmless Agreement: Kirat Enterprises, Inc. will not be held responsible for accident or injury to the student(s) while they are in the classroom, on a field trip, or while they are on the way to the classroom or trip, except as shall be covered by the school insurance.
1. Trial Period: All children are subject to a six-week probationary period at their initial entry and at the beginning of each subsequent school year. The school reserves the right to ask any parent to withdraw their child at any time, for any reason, and at its complete discretion, and reserves the right to deny, cancel or suspend a child’s enrollment if deemed in the best interest of the child or the school. 2. Cooperative Undertaking: Education is recognized as a cooperative undertaking, a responsibility held jointly by the parents or guardians and the school. Upon signing this enrollment application, you agree along with the student to accept the full share of this responsibility, to maintain the academic standards and to fulfill your obligations as a cooperative member of the school community. These obligations include, but are not limited to, participating in school activities, supporting the school’s philosophy and policies, staying informed by reading school communications and communicating openly, constructively and in a civil manner with all school personnel. This contract may be cancelled and the student dismissed by the school in the event that the school determines that the parents or guardians are not supportive of the school’s goals and policies and that a mutually beneficial relationship is no longer tenable. 3. Application Fee: The non-refundable $100 application fee must to be submitted with this application. 4. Enrollment Fee: Upon completion of a successful student visit and notification from the school office, a $350 non-refundable enrollment fee must be submitted to reserve your child’s place for the 2019 – 2020 school year. Without the enrollment fee, your child is not guaranteed placement for the 2019 – 2020 school year. 5. Supply & Activity Fee: A $500 supply and activity fee for all students must be submitted by August 1, 2019. The supply and activity fee covers all field trips, admission prices, and in-house field trips as well as daily snacks and supplies. All Upper Elementary overnight trips will be billed separately. 6. Tuition Payment: The annual school tuition is paid in 10 monthly installments. The 10 tuition installments are due August 2019 through May 2020, on the first school day of each month. 7. Late Fee: There is a late fee of 5% of the amount due for payments more than 3 days late. Tuition payments 10 days or more in arrears, will result in the dismissal of your child from the program. 8. Return Check Fee: There is a $75 fee for payments returned due to insufficient funds. If a check is returned for insufficient funds, your future payments will need to be in the form of a bank check. 9. Financial Obligations: Contracts are to insure the stability of the school and are strictly enforced. Paint Branch Montessori School will not refund tuition or cancel unpaid obligations if the accepted student withdraws after the 6-week trial period. After the 6-week trial period, if you choose to withdraw your child before the school year is completed, you are still contractually responsible for the balance of the tuition payment and any legal fees incurred. 10. Collection Fees: In the event that the school undertakes collection procedures with respect to this contract, the parents/guardians will be responsible for and agree to pay the school all costs of collection, including but not limited to, court costs and attorneys’ fees. 11. Half Day & Full Day Early Arrival: Children not registered for All Day who arrive before 8:45am will be checked into Drop-in Before Care and will be charged the daily drop-in rate of $20. Payment is due, to the school office, on the day of service. There is a late fee of 5% of the amount due for payments more than 3 days late. Payments 10 days or more in arrears will result in the dismissal of your child from the program. 12. Half Day & Full Day Late Pick Up: Children picked up after 12:00pm (Half Day Program) or 3:00pm (Full Day Program) will be checked into Drop-in After Care and will be charged the daily drop-in rate of $45. Payment is due, to the school office, on the day of service. There is a late fee of 5% of the amount due for payments more than 3 days late. Payments 10 days or more in arrears will result in the dismissal of your child from the program. 13. All Day Early Arrival: All Day starts at 7:30am. Due to legal issues, staff cannot allow any student to enter the building before the opening time of 7:30am. 14. All Day Late Pick Up: All Day hours only extend to the closing time of 6:00pm. There is a fee of $5 per minute ($15 minimum) for any late pickups after 6:00pm. Payment is due, to the school office, upon receipt of the invoice. There is a late fee of 5% of the amount due for payments more than 3 days late. Payments 10 days or more in arrears will result in the dismissal of your child from the program. If your child is picked up late more than 3 times this will result in their dismissal from the After Care program. 15. Schedule Changes: Only one schedule change per school year is allowed with a $200 service fee. There is no credit for missed days. PBMS requires two-week advance notice for any schedule changes. 16. School Inclement Weather Hours: PBMS follows Montgomery County Public Schools (MCPS) inclement weather policy. Please Note: There is no Before Care on late opening days There is no morning Half Day program on late opening days If MCPS opens 2 hours late, PBMS opens at 10:45am If MCPS closes 2 hours early, PBMS closes at 12:45pm There is no After Care on early dismissal days 17. Authorization for Releasing Children: For security reasons, your child will only be permitted to leave with the authorized people listed on the student release form, unless prior authorization is provided. Any individuals that staff are not acquainted with, will be required to show identification when coming to pick up your child. 18. Health Records: If your child has special needs or requirements, please notify the school office in writing. No student will be admitted to the school unless we have their complete Health Records. 19. Medication: PBMS Staff can administer medication only if we have the medication authorization form filled out by the guardian and doctor. Students with allergies, asthma or medical conditions must have this form completed and on file in the school office, before their first day of school. 20. Sick Child: If a child becomes ill at school with vomiting, fever, diarrhea, or shows any symptoms that we feel need attention, we expect the child to be picked up immediately. Children can only return to school when they have been symptom free for 24 hours. 21. Non-discrimination: PBMS does not discriminate on the basis of race, color, religion, or national origin in the admission of students, or employment of faculty and administrative staff. 22. Falsified Information: PBMS reserves the right to withdraw acceptance or dismiss the applicant from the school in the case that incomplete or incorrect information has been provided. The information collected by the school is confidential and is intended only for PBMS purposes. 23. Hold Harmless Agreement: Kirat Enterprises, Inc. will not be held responsible for accident or injury to the student(s) while they are in the classroom, on a field trip, or while they are on the way to the classroom or trip, except as shall be covered by the school insurance.
Please check the box beside the statement.
I have read and understand the PBMS Legal Policy & Fee Agreement and will abide to the terms and conditions of this agreement.
Signature of Parent or Guardian
Name of Parent or Guardian
Date
Date Format: MM slash DD slash YYYY

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