THE ArTS CONNECTION

renaissance Academy Kindergarten

Enrollment Application 2010-11
#1-12491 No. 2 road, richmond V7E 3M2
Phone: (604) 241-0826 Fax: (604) 241-0400
Email: kids@theartsconnection.org
Website: www.theartsconnection.org
Students Name

Birthdate (dd/mm/yyyy)

__________________________________

____________________

Age
_________
M
___

Address (Street Number, Street Name, City)

F
___

Postal Code

______________________________________________________________________________
Home Phone
Email Address
______________________________________________________________________________
Mothers Name
Cell/Business Phone
______________________________________________________________________________
Fathers Name
Cell/Business Phone
______________________________________________________________________________
Does your child have any allergies or serious medical issues?

Yes ___

No ___

If yes, please explain:_____________________________________________________________________

_______________________________________________________________________________________
Full Day
(8:45am - 3:00pm)

Half Day AM
(8:45am - 12:45pm)

Half Day PM
(1:00 - 5:00pm)

Optional Before School Care

(Mon - Fri, 7:15 - 8:45am)
Optional After School Care
(Mon - Fri, 3:00 - 6:00pm)

Signature of Parent/Guardian______________________________ Date: ________________________

OFFICE USE ONLY

Registration: In person ____

By fax ____

Payment Method: Cash ____

Chq ____

Application fee: $140.00

By Email ____

Date: _________________

CC ____

Educational Package: $392.00

Deposit of Last Month's Fees: $__________

Total Fees: $__________ (fees include taxes)