EXTENDED DAY APPLICATION

BEFORE YOU BEGIN

If applying for a scholarship, you must be able to upload proof of income in the following forms:

Most recent year tax return and W2

Two most recent paystubs

Select NEXT if you are ready to begin.

Enrollment Type (Choose One)(Required)

Before Care Services

After Care Services

Before and After Care Services

Your Monthly Cost Before Scholarships: $80.00

Our staff will inform you of multi-child discounts if applicable.

Your Monthly Cost Before Scholarships: $200.00

Our staff will inform you of multi-child discounts if applicable.

Your Monthly Cost Before Scholarships: $280.00

Our staff will inform you of multi-child discounts if applicable.

Student Information

Student Name(Required)

Address(Required)

Date of Birth(Required)

Grade(Required)

Family Information

Primary Parent/ Guardian Name(Required)

Address(Required)

Cell Phone(Required)

Alternate Phone

Email(Required)

Would you like to add a second parent/guardian?(Required)

YES

NO

Second Parent/Guardian Name

2nd Parent/Guardian Address

2nd Parent/Guardian Cell Phone

2nd Parent/Guardian Alternate Phone

2nd Parent/Guardian Email

Pick Up Authorization

Authorized persons must be an adult or an older sibling in high school or above. We will only allow your child to leave the premises with the persons listed below. In the event that we cannot reach you for late pick-ups, we will contact the individuals listed here. At least one contact is required.

Contact 1: Name(Required)

Contact 1: Relationship(Required)

Contact 1: Phone(Required)

Contact 2: Name

Contact 2: Relationship

Contact 2: Phone

Contact 3: Name

Contact 3: Relationship

Contact 3: Phone

Medical Information

DOES YOUR CHILD TAKE ANY MEDICATION?(Required)

YES

NO

List Medications - If not applicable enter N/A(Required)

DOES YOUR CHILD HAVE ANY ALLERGIES OR FOOD ALLERGIES?(Required)

YES

NO

List All Allergies - If not applicable enter N/A(Required)

Medications will NOT be administered during extended care services.

Scholarship Request

Please note that scholarships are awarded based on each applicant’s need, good standing with the organization, and available scholarships. Completing this application does not guarantee that a scholarship will be issued. All applicants must submit a most recent tax return, W2, and two (2) recent paystubs as proof of income. Applicant may also submit a recent public assistance benefit letter listing your annual income.

Are you applying for financial assistance?(Required)

YES

NO

NOTICE OF NON-DISCRIMINATORY POLICY RELATED TO STUDENTS

The Biome School strictly prohibits discrimination and harassment against employees, students, or others on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, familial status, disability, age, veteran status, genetic information, or any other characteristic protected by law.

The undersigned hereby agree(s) to pay The Biome School for all fees associated with my/our child(ren) attending The Biome extended day services. I/we further understand that all fees are due by the 5th of each month, and if any payments remain outstanding for 2 weeks or more, my/, our child (ren) may be prohibited from attending any further sessions at The Biome until all outstanding fees are paid and my/our account is current. Further, I/we understand that if any fees owed to The Biome remain outstanding for 120 days or more, The Biome will pursue all collection efforts and practices, including referring your account to a collection agency and/or attorney and reporting to the credit bureau. Your account will be assessed for all additional collection charges associated with the collection of the debt, including but not limited to: collection agency fees, reasonable attorney’s fees, court costs, and all other charges allowed by law.

By submitting this application, I attest that I have submitted true and factual information to the best of my knowledge. I understand that submitting this application is the first step towards enrollment but is not an enrollment form. By completing this application correctly and notifying us of changes, we guarantee that you will be contacted if the student is accepted. If the student is accepted because you submitted false, incorrect or misleading information, we may refuse to enroll the student.

Student Contract Statements(Required)

I will seek excellence in all my endeavors, be a model of high achievement, and positively represent my family and The Biome School.

I will respect all staff and learners.

I understand that disrespectful acts and failure to follow instructions from those in authority, may result in dismissal from the program.

As part of the registration process, all families must read and agree to all the Student Contract statements.

Parent Contract Statements(Required)

I understand and agree that outstanding fees from previous school years must be paid prior to acceptance in the program.

I understand and agree that payments for services are due by the 5th of every month to prevent suspension from the program.

I understand and agree that I will ensure that my child arrives no earlier than 6:30 am, is picked up no later than 6:00 pm.

I understand and agree that if my learner is picked up after 6:00 pm, I will be assessed a $25 fee, per incident, per learner.

I understand and agree to attend the Parent Orientation, which will be held prior to the start of the school year.

I acknowledge receipt of the Parent Handbook. It is my responsibility to read and comply with the policies.

As part of the registration process, all families must read and agree to all the Parent Contract statements.

Signature(Required)

Application Date(Required)

EXTENDED DAY

Apply to the Extended Day Program Today

Extended Day Services Registration Form

BEFORE YOU BEGIN

Your Monthly Cost Before Scholarships: $80.00

Your Monthly Cost Before Scholarships: $200.00

Your Monthly Cost Before Scholarships: $280.00

Student Information

Family Information

Pick Up Authorization

Medical Information

Scholarship Request

NOTICE OF NON-DISCRIMINATORY POLICY RELATED TO STUDENTS

4471 OLIVE STREET, SAINT LOUIS, MO 63108 | 1-314-531-0982 | CONTACT

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