Piper LA | 2019-2020 Johnny AM Contract | 5 Day

Child's First Name*

Child's Last Name*

Child's Date of Birth*

Child's Gender*

Male
Female

Parent A First Name*

Parent A Last Name*

Paren A Address*

Street Address City State / Province / Region ZIP / Postal Code

Parent A Phone*

Parent A Email*

Enter Email Once more for the people in the back.

Is there another parent in the picture?*

Yes
No

Parent B First Name*

Parent B Last Name*

Parent B Email*

Enter Email Once more for the people in the back.

Parent B Phone*

Policies and Agreements

Family Information*

I understand that a link requesting additional family information will be sent to me and must be returned to complete my child's enrollment. The Family Information link will request information including, but not limited to, emergency contacts, caregiver authorizations, and details for class rosters. By checking this box, I agree to submit my Family Information prior to the start of school as a condition of my child's enrollment.

Physician's Report*

I agree to submit an electronic copy of LIC701 Physician's Report, as it is required by law to be on file prior to attendance.

Class Placement*

I accept Piper's offer to enroll my child into the Johnny AM program.

Separation Policy*

I understand that for the first two weeks of school my child's transition schedule will be 9:30am-11:30am, and that a parent or caregiver must be present the entire time. I understand that separation will be determined individually and as needed. By checking this box, I acknowledge and agree to the Separation Policy.

Weekly Schedule*

By selecting a weekly schedule below, I understand that I am selecting an annual schedule for my child in accordance with the 2019-2020 school calendar.

5 Days: Monday-Friday

Daily Schedule*

By selecting a daily schedule below, I understand that I am selecting an annual schedule for my child, and that the associated tuition is for the 2019-2020 school year. I understand that the Annual Fee includes PPA* dues, Materials Costs, and Earthquake & Safety Supplies. *The Preschool Parent Association (PPA) sponsors parent education programs, faculty support, community activities, and family events.

9am-12pm

Early Morning Drop-Off*

Early Morning Drop-Off includes supervision on the playground and is available Monday-Friday from 8:15am-9am, in accordance with the school calendar. By selecting below, my child will be enrolled in Early Morning Drop-Off and may attend any or all days. I understand that the associated fee is for the 2019-2020 school year, is non-refundable, and will be added to my Total Commitment. *If selected, you will be invoiced for a prorated amount based on enrollment date.

Early Morning Drop-Off: 8:15am-9am | $2800
N/A

Tuition Agreement*

Monday-Friday | 9am-12pm: $15,400 | Annual Fees*: $800 = Total Commitment: $16,200. I understand that upon completing and submitting this contract, I will be securing my child's enrollment with a deposit of $2,500. I understand that this payment is non-refundable, regardless of my child's absence, withdrawal, or relocation, and will be directly applied to the Total Commitment. I understand that this agreement and deposit must be received within 10 days of issuance. I understand that if I do not meet the deadline, Piper Preschool will not be obligated to reserve a space for my child. *The term “Annual Fees” includes PPA Dues, Materials Costs, and Earthquake & Safety Supplies. The Preschool Parent Association (PPA) sponsors parent education programs, faculty support, community activities, and family events. By checking this box, I acknowledge the Tuition Agreement and understand that I am responsible for the Total Commitment, regardless of my payment plan. *Tuition will be prorated to reflect an April 13, 2020 enrollment date.

Payment Options*

Select your payment plan below. Accepted methods of payment include check, bank withdrawal, and credit card. Note: Any credit card payment, other than this deposit, will incur a 3% convenience fee. *Amount prorated to reflect an April 13, 2020 enrollment date.

One Payment: $1,380 due on April 1, 2020.
Three Payments: Balance divided into three equal payments of $485; Each payment is due on the 1st of each month, beginning April 1, 2020 and concluding June 1, 2020. This payment plan requires automatic payments and includes a $25 per payment finance fee.

Payment Type*

Bank Account: I authorize Piper Preschool to withdrawal each monthly payment from the bank account listed below.
Credit Card: I authorize Piper Preschool to charge the credit card listed below, plus a 3% processing fee, for each monthly payment.

Payment Type*

Credit Card: I authorize Piper Preschool to charge the credit card listed below for the balance of my Total Commitment, plus a 3% processing fee, on March 1, 2019.
Bank Account: I authorize Piper Preschool to withdrawal my payment(s) due from the bank account listed below.

Bank Name*

Account Holder's Name*

Account Holder's Phone*

Bank Routing Number*

Bank Account Number*

Account Type*

Checkings
Savings

Name on Credit Card*

Credit Card Number*

CVV*

Expiration Date*

Phone Number Associated with Card*

Billing Address*

Street Address City State ZIP Code

Late Payment Policy*

By checking this box, I understand that any payment not received by the due date outlined in my Tuition Agreement, as well as any declined payment, will incur a $25 fee, and that any returned check or returned bank debit transaction will result in an additional $12 fee. Payments not received and/or successfully processed within 10 days of the due date will also incur a fee equal to 10% of the total amount due. An additional fee, equal to 10% of the accrued amount due, will be applied every 15 days until the balance due is fulfilled. I understand that, should any balance remain outstanding after 90 days of the original due date, my child’s admissions status may be adversely affected, as Piper has the right to discontinue enrollment.

Liability and Refund Policy*

By checking this box, I understand the Total Commitment to represent an annual commitment; I understand that my obligation to pay tuition and fees for the entire school year, as outlined above, is unconditional, and that no portion of tuition and fees, be it paid or outstanding, will be refunded nor canceled in the event of absence or withdrawal. I understand that the timing of payments is not associated with my child’s time of attendance, regardless of my payment plan. I understand all payments are non-refundable. Should I move out of the LA area, I understand that a prorated refund/release may be requested following a 60-day notice of departure.

Parents' Rights - LIC995*

As a Parent/Authorized Representative, you have the right to: 1. Enter and inspect the child care center without advance notice whenever children are in care. 2. File a complaint against the licensee with the licensing office and review the licensee’s public file kept by the licensing office. 3. Review, at the child care center, reports of licensing visits and substantiated complaints against the licensee made during the last three years. 4. Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child. 5. Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a court order. 6. Receive from the licensee the name, address and telephone number of the local licensing office. 7. Be informed by the licensee, upon request, of the name and type of association to the child care center for any adult who has been granted a criminal record exemption, and that the name of the person may also be obtained by contacting the local licensing office. 8. Receive, from the licensee, the Caregiver Background Check Process form. NOTE: CALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE POSES A RISK TO CHILDREN IN CARE. ACKNOWLEDGEMENT OF NOTIFICATION OF PARENTS’ RIGHTS: I, the parent/authorized representative of the child named within this form, have read and understand my rights as outlined on form LIC 995. I understand that if I wish to have a hard copy of this information, it is available to me in the main office at Piper Preschool.

I acknowledge and understand Parents' Rights.

Personal Rights - LIC613A*

Each child receiving services from a Child Care Center shall have rights which include, but are not limited to, the following: 1. To be accorded dignity in his/her personal relationships with staff and other persons. 2. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. 3. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or actions of a punitive nature, including but not limited to: interference with daily functions, i.e. eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. 4. To be informed, and to have his/her authorized representative, if any, informed by the licensee of the provisions of law regarding complaints including, but not limited to, the address and telephone number of the complaint receiving unit of the licensing agency and of information regarding confidentiality. 5. To be free to attend religious services or activities of his/her choice and to have visits from the spiritual advisor of his/her choice. Attendance at religious services, either in or outside the facility, shall be on a completely voluntary basis. In Child Care Centers, decisions concerning attendance at religious services or visits from spiritual advisors shall be made by the parent(s), or guardian(s) of the child. 6. Not to be locked in any room, building, or facility premises by day or night. 7. Not to be placed in any restraining device, except a supportive restraint approved in advance by the licensing agency. THE REPRESENTATIVE/PARENT/GUARDIAN HAS THE RIGHT TO BE INFORMED OF THE APPROPRIATE LICENSING AGENCY TO CONTACT REGARDING COMPLAINTS: CA Department of Social Services | Los Angeles Northwest Office 6167 Bristol Parkway #400 Culver City, CA 90230 310.337.4335 TO: PARENT/GUARDIAN/CHILD OR AUTHORIZED REPRESENTATIVE: Upon satisfactory and full disclosure of the personal rights as explained, complete the following acknowledgment: ACKNOWLEDGMENT: I/We have been personally advised of, and have read above the personal rights contained in the California Code of Regulations, Title 22, at the time of admission to: Piper Preschool | 807 Arizona Ave, Santa Monica, CA 90401. I understand that if I wish to have a hard copy of this information, it is available to me in the main office at Piper Preschool.

I acknowledge and understand Personal Rights.

Code of Conduct*

By checking this box, I understand that Piper Preschool reserves the right to discontinue enrollment in the event of a breach of this agreement and/or failure to adhere to the Parent Code of Conduct, as outlined in the Parent Handbook.

Enrollment Completion*

Checking this box, signing below, and submitting my deposit signifies that I have read, understand, and agree to all terms and policies listed throughout this complete contract, agree to its provisions, and that I will be responsible for the Total Commitment. I have viewed and agree to the School Calendar and understand that Piper reserves the right to make changes. I have read, understand, and agree to the Parent Handbook, and understand that the 2019-2020 version will be issued in August 2019 and will reflect the policies applicable to the 2019-2020 school year. I acknowledge that my information on this contract is correct, and authorize Piper Preschool to use this information as needed.

Signature*

Deposit

Tuition Deposit*

This enrollment deposit must be paid with a credit card.

Price: $2,500.00

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Policies and Agreements

Deposit

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