Enrollment Application

PETTENGILL ACADEMY
ENROLLMENT APPLICATION

Please fill the information below, it is required by both State of Maine laws and Pettengill Academy policies that this form is filled out completely. If any spaces are left blank it may cause delays in enrollment and/or ability to access information with our digital communication software, as will any information not written legibly or neatly.

This Enrollment Application will initiate the enrollment process with Pettengill Academy for care, but does not guarantee Enrollment. Only once all the required paperwork has been completed and submitted will it move forward in the Application process. At all times during this process a member of our schools will be available to assist in the successful completion of the paperwork and help answer any questions you may have.

The Pettengill Academy Family Guide and Handbook explains all of the policies in place at the childcare center. This agreement is reviewed annually. If changes are made to the Family Guide and Handbook at any time, families will be notified in writing a minimum of two weeks in advance. If any term or condition stated below or in the Family Guide and Handbook conflicts with any rule or requirement governing the Licensing of Childcare Facilities in Maine or any other applicable rule of law, it shall be of no force and effect and the applicable legal standards shall govern.

Pettengill Academy bases enrollment on spots. Spot care means that as a family you enroll for specific days, 2 - 5 days based on your needs. Tuition is due regardless of how many days you attend that week as the spot is held for the student, not hours of attendance.

If you were referred by a friend, please tell us who it was so we can thank them!

1 - Select your location

Which campus are you enrolling at:(Required)

2 - Student Information and Schedule

Parent's Name:(Required)

This contract is between : (Parent's names listed above)(herein called Parents(s)) and Pettengill Academy (herein called Provider).

Childcare services will be provided by the Provider for the following student :
For additional students please fill out a separate Contract and Enrollment Agreement.

Student’s Full Legal Name:(Required)

Date of Birth: (As verified by Immunization Records)(Required)

Gender:(Required)

Physical Address:(Required)

Mailing Address:(Required)

Student’s Physician:(Required)

Physician Phone Number:(Required)

Physician’s Address:(Required)

Student’s Dentist:(Required)

Dentist Phone Number:(Required)

Dentist Address:(Required)

Allergies to Medications:

Any other Allergies:

Please note all medications for which the child is currently receiving treatment:

Please list any existing medical conditions, medications or special attention your student may require:

** For allergies, Pettengill Academy requires a Plan of Action from your student’s Physician.

Emergency Medical Treatment Authorization Form

This grants temporary authority to Pettengill Academy to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal guardians, and it may not be feasible or practical to contact them. This form should accompany the minor in the event of off-site or emergency relocation of the program.

Schedule and Contract Days
Full Time is 4 - 5 days, Monday through Friday
Part Time has two options : Mon, Wed & Fri or Tue & Thu
- Families can choose between either offering, but are locked into those set days.

** Any adjustments on a continued basis to this schedule will require approval by the Director and an updated Enrollment Agreement. Any changes to rates and dates are subject to current Tuition Rates and Tuition Policies active at the time of the signing of the new Enrollment Agreement as selected in the Family Guide and Handbook.

Date you are looking to start:(Required)

Please indicate which days you are looking for care :(Required)

Full Time: Mon - Fri

Part Time: Mon, Wed & Fri

Part Time: Tue & Thu

2a - Extended Drop Off

Pettengill Academy offers an Extended Drop Off option for parents and families. Normally students are not allowed to be dropped off after 9am, but we offer an option for families to extend this Morning Drop Off period. Families now have the option to drop off anytime before 10:30 am by adding this extra service For $30 a week in addition to the normal tuition rate. This is only currently available for our private pay families.

Please sign below to add our Extended Drop Off option to your account.

Signature:

Date:

3 - Payments and Determining Start Date

Methods of Payment :
Your initial payment only, will be made through Venmo. Then all other payments will be set up through our Auto ACH process to be done every Friday.

After turning in your paperwork you’ll be contacted by the School Director or a member of our Home Office to schedule a Parent Orientation call as well as send you an email invoice to complete the Initial payment through our myprocare.com portal. They will review all paperwork to ensure everything is completely filled out and we have all required paperwork and check to see the payment has been made. They will also review Basic Policies and go over what the First Day will entail and set you up with a start date.

Initial Payment : Your Initial Payment will consist of one week’s tuition and a $160 Application Fee ( the Application Fee is non-refundable ).

Payments : Payments are paid in advance for the upcoming week. Payments are due by 5:30pm every Friday.

Prior to Start Date :minimum of 1 week prior to start date : Contract and Financial Agreement, Family Guidebook forms, Immunization Records, Allergy Management forms, Emergency Medical Treatment Authorization as well as CACFP forms.

Contract Renewal : This Contract and Financial Agreement renews with each tuition payment made. When tuition payments are not made this contract will expire until such payments are made. Pettengill Academy reserves the right to unenroll students and parents with expired contracts, in the event a student is unenrolled they can be placed on a waitlist for re-admittance.

Re-admittance : If a student is un enrolled due to lack of tuition payment, they will be placed on a waitlist and the parent will need to re enroll by completing a new Contract and Financial Agreement as well as paying all tuition and fees as normally due, in addition to paying any prior balance as owed.

Registration Fee Schedule :

2nd Friday in February	$35
2nd Friday in April	$35
2nd Friday in August	$35
2nd Friday in October	$35

Miscellaneous :

4 - Food & Allergy Notice

5 - Parent/Guardian Information

Parent/Guardian 1 ( This is the person who will be listed first in our system, the “Primary” )

First and Last Name:(Required)

Physical Address:(Required)

Mailing Address:(Required)

Phone/Cellphone Number:(Required)

Cellphone Carrier:(Required)

Email Address:(Required)

Employer:(Required)

Employer Address:(Required)

Work Phone Number:(Required)

Parent/Guardian 2 ( This is the person who will be listed first in our system, the “Secondary” )

First and Last Name:

Physical Address:

Mailing Address:

Phone/Cellphone Number:

Cellphone Carrier:

Email Address:

Employer:

Employer Address:

Work Phone Number:

*By providing Pettengill Academy with your cell phone carrier, you give us permission to send text notifications to you.

6 - Alternative Pick Up & Emergency Contact Information

Please list people who are permitted to pick up your student and who we can contact in the event when we are unable to reach you. Identify Verification will be required for the following people.

First and Last Name:(Required)

Physical Address:(Required)

Phone/Cellphone Number:(Required)

Relationship to the Student:(Required)

First and Last Name:

Physical Address:

Phone/Cellphone Number:

Relationship to the Student:

First and Last Name:

Physical Address:

Phone/Cellphone Number:

Relationship to the Student:

7 - Fee’s and Other Information

Procare App :
Pettengill Academy utilizes an app called Procare as a digital communication tool between parents and the provider. This is how you will Check In and Check out every day. To get the full Pettengill Academy experience we do expect parents to download this free app. Pettengill Academy will send out reminders, messages, daily reports and updates for your students using this app.

Additional Fees :
Families are expected to pay any of the following additional fees within 24 hours.

Bounced Check or Declined Card : $30 fee plus any other fees Provider incurs.
Late Payment : $25. This fee will be added for payments not made by 5:30pm Friday.
Late Pick Up : $20 every five minutes, per student.
Example 1 : 5:30 - 5:35 = $20 / 5:35 - 5:40 = $40 / 5:40 - 5:45 = $60
Example 2 : If you pick up at 5:41 pm your late fee will be $60 per student, so if you have 2 students picked up at 5:41 pm your late fee will be $120.

Trial Period :
There will be a Trial Period of 30 calendar days, beginning on the student’s first day of care. During this time period either the Parent or the Provider may terminate this agreement without further obligation. No fees, including the registration and or enrollment fee, will be refunded if this agreement is terminated during the Trial Period. This does not apply to contract renewals.

Bus/Transportation Policy :
Pettengill Academy does not offer busing or transportation services.

Pettengill Academy is not able to accommodate pickup or drop offs for school or visitations prior to 7:50am.

Attendance & Drop off Policy :
Students are expected to be in attendance by 9am. Pettengill Academy does understand that at various times parents will need to drop off later due to appointments or unscheduled events such as an emergency. Students not in attendance prior to 9am will not be able to attend for the day unless.
1. Families are required to send a message through Procare a minimum of the day before a Late Arrival.
2. For families that call the day of, we can not guarantee a spot for attendance.

Check In & Out :
Parents are required to Check In and Check Out students at drop off and pick ups every day they are in attendance. You can do this right from your Procare App you can scan one of the QR codes found in the front of the building. Authorized Pick Ups must first register with the Front Desk.

Termination :
Parents and Provider agree to give a two week written notice of intent to terminate this agreement. Two weeks of any fees and tuition are due even if the student is not in attendance. In the event a notice is not given, fees and tuition are still due for two weeks of care.
The Provider reserves the right to issue an immediate termination of this contract for any reason, including the following, but are not limited too :
Lack of compliance with Family Guide and Handbook policies, non payment of tuition, late payments, bounced checks, lack of parental cooperation, disrespect, failure to complete and return required forms, physical or verbal abuse of any person or property on the school premises, continual disciplinary problems, false information given by parents, three or more late pickups in a 30 day period, failure to comply with all necessary COVID policies or health policies.

Force Majeure :
Neither party shall be held liable or responsible to the other party nor be deemed to have defaulted under or breached this Agreement for failure or delay in fulfilling or performing any obligation under this Agreement when such failure or delay is caused by or results from causes beyond the reasonable control of the affected party, including but not limited to fire, floods, embargoes, war, acts of war, insurrections, riots, strikes, lockouts or other labor disturbances, or acts of God; provided, however, that the party so affected shall use reasonable commercial efforts to avoid or remove such causes of nonperformance, and shall continue performance hereunder with reasonable dispatch whenever such causes are removed. Either party shall provide the other party with prompt written notice of any delay or failure to perform that occurs by reason of force majeure.

8 - Well Care and Medication Policy Acknowledgements

9 - Incident/Behavior Reports

10 - Acknowledgments and Signatures

This agreement contains the entire understanding between both parties and supersedes any prior understandings and/or written or oral agreements between them. Any agreement hereafter shall not change nor terminate this agreement, unless it is in writing and signed by both parties.

I understand that upon acceptance by a duly authorized representative of Pettengill Academy, this agreement will constitute a binding contract between the undersigned and Pettengill Academy.

Parent/Guardian 1 Name:(Required)

Date:(Required)

Parent/Guardian 1 Signature:(Required)

Parent/Guardian 2 Name:

Date:

Parent/Guardian 2 Signature:

Enrollment Application

PETTENGILL ACADEMY ENROLLMENT APPLICATION

1 - Select your location

2 - Student Information and Schedule

Emergency Medical Treatment Authorization Form

2a - Extended Drop Off

3 - Payments and Determining Start Date

4 - Food & Allergy Notice

5 - Parent/Guardian Information

6 - Alternative Pick Up & Emergency Contact Information

7 - Fee’s and Other Information

8 - Well Care and Medication Policy Acknowledgements

9 - Incident/Behavior Reports

10 - Acknowledgments and Signatures

Have Questions?

PETTENGILL ACADEMY
ENROLLMENT APPLICATION