IWM Encore & Tuition Based Programs

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Registration Form

Parent/Guardian Name *

Student(s) Name *

School Year *

2023-2024

2024-2025

Student(s) Grade(s) *

VPK

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Seventh Grade

Required

Email Address *

Home Address *

Parent/Guardian Phone number *

Emergency Contact Person / Phone Number *

Does your child have any allergies? *

Authorized People to pick up / Phone Number *

TUITION BASED PROGRAM ELECTION

Acknowledgement of Registration Fee *

I understand that there is a $25 registration fee per child, $50 for a family to enroll. This fee must be received prior to enrollment being finalized.

In which program would you like to enroll? *

Before Care - $30 per week, per child (6:30am - 7:30am)

After Care - $90 per week, per child (3pm - 6pm)

Before & After Care - $120 per week, per child (6:30am - 7:30am) & (3pm - 6pm)

Drop In as needed - $25 per session (Before or After Care)

VPK Wrap - $90 per week, per child (11:30am - 3:00pm)

VPK Extended Day - $120 per week per child (11:30am - 6:00pm)

Required

Late Pick up Acknowledgement *

I understand that I must pick up my child by the pick up time associated with my program of choice. Time is calculated by utilizing the front office clock. The late pick up fee is $1 per minute, per child.

Payment Due Dates *

I understand that payment must be submitted no later than Friday of the week prior to service. IWM is a prepay program.

Late Fees *

I understand that if payment is not received by Tuesday of the week of service, I will be responsible to pay a $10 late fee. Accounts that are more than a week delinquent may result in removal from the program.

Check Return Fee *

I understand that there will be a $35.00 fee for each CHECK RETURNED for insufficient funds. Every subsequent payment will be required to be in the form of cashier’s check or money order.

Payment Types Accepted *

I understand that payment must be provided by credit card, check, or money order. NO CASH will be accepted for tuition payments.

STUDENT CONDUCT EXPECTATIONS

Student Conduct *

I understand that my child and I are expected to follow the Imagine Schools at West Melbourne Student Code of Conduct and abide by the Parent/Student Handbook rules and regulations.

PARENT / GUARDIAN ACKNOWLEDGEMENT

If you have any questions prior to signing the acknowledgement, please contact us at 321-768-6200

Acknowledgement & Registration *

I acknowledge that I fully understand my financial obligations as well as the program guidelines and expectations.

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