Application Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=95 BGCOLOR="#FF0000" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Times New Roman" ><B>  </B></FONT><B>  </B><B> </B><B>|   </B><A HREF="index.htm" TARGET="_top" TITLE=" "><U><B>home</B></U></A></div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="id2.htm" TARGET="_top" TITLE="About SMaRT Fun"><U>About SMaRT Fun</U></A>   |   <A HREF="id27.htm" TARGET="_top" TITLE="SMaRT Fun Philosophy"><U>SMaRT Fun Philosophy</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="About The Director / Teacher"><U>About The Director / Teacher</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Tour The Building"><U>Tour The Building</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Class Rules"><U>Class Rules</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Class Schedule"><U>Class Schedule</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="Tuition Rates"><U>Tuition Rates</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Scholorship Requests"><U>Scholorship Requests</U></A>   |   <B>Application Form</B></div> <div> </div> </td> </tr><tr> <td valign="top" height=385 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Application Form</I></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>SMaRT FUN Learning Adventures</B></div> <div> <B>Student Registration</B></div> <div> Registration for the <B>2010 fall</B> semester is $25.00 per student. <B>Register before Aug. 30 for only $15!</B> Registration payments are nonrefundable. Admissions to SMaRT FUN Learning Adventures are ongoing throughout the year as space is available. We are currently open as a kindergarten prep program (Pre-K) for ages 4 and 5 and kindergarten.</div> <bR> <div> <I>Today's Date:_______________       </I></div> <div>                                                                     Circle One</div> <div> Student's Name:  _____________________________________     DOB:___________________ M  or   F</div> <bR> <div> Student's Name:  _____________________________________     DOB:___________________ M  or   F</div> <bR> <div> Student's Name:  _____________________________________     DOB:___________________ M  or   F</div> <bR> <div> Mother/Guardian: __________________________________________________________________</div> <div>                </div> <div>        Employer: ____________________________  Wk Ph: _________________________</div> <div>        </div> <div>   Mailing Address: ____________________________________________________________</div> <div>      </div> <div>  Mother Home Ph: ______________________   Cell Ph:_________________________ </div> <bR> <div>  Email: ________________________________________________________________</div> <bR> <div> Father/Guardian: __________________________________________________________________</div> <div>      </div> <div>  Employer: ____________________________  Wk Ph: _________________________</div> <div>        </div> <div>  Mailing Address: _____________________________________________________________</div> <div>      </div> <div>  Father Home Ph: ______________________   Cell Ph:_________________________ </div> <bR> <div>  Email: _______________________________________________________________</div> <div>      </div> <div> If you are divorced, please supply a copy of the divorce judgment.</div> <div> If you are a non-parental guardian, please supply a copy of the court order.</div> <bR> <div> Yearly tuitions are:  Pre-K $1,080       Kindergarten $2,000   </div> <div> <I>You may break it down in payments as follows - discounts applied on some payment plans</I>:</div> <div> <B>Select program and payment method desired:</B></div> <div> <B>____Pre-K</B>           Payment method desired:  Weekly plan $30______  Monthly plan $105_____   Semester plan $500______    </div> <div>                                                     Due each Monday morning      Due the first of each month          Due by the beginning of each semester</div> <div>                                for 36 weeks            for 10 months: Sept - June       (for total of 2 payments)</div> <div> <B>____Kindergarten  </B>Payment method desired: Monthly plan $200_____  Semester plan $950_____     Payment in full $1800 ____</div> <div>                            <FONT SIZE="1" COLOR="#000000" FACE="Arial" >Due the first of each month          Due beginning of each semester       Due on or by the first day of school</FONT></div> <div>   <FONT SIZE="1" COLOR="#000000" FACE="Arial" >                             for 10 months: Sept - June        (for total of 2 payments)</FONT></div> <div> Signature: ______________________________________________ Date: __________________</div> <div>                     <FONT SIZE="1" COLOR="#000000" FACE="Arial" >(mother/guardian)</FONT></div> <div> Signature: ______________________________________________ Date: __________________</div> <div>                       <FONT SIZE="1" COLOR="#000000" FACE="Arial" >(father/guardian)</FONT></div> </td> </tr></table></body>