Children S Learning Center Date Received______

Children’s Learning Center Date Received______

Application Form Time Received______

Evening Care

APPLICATION FEE: Please enclose fee of $15 per child with this application. Applications must be received by December 30 to be considered for Spring semester.

Date of Application: ______

Dates desired for enrollment: Begin ______End ______

CHILD’S NAME: ______

Child’s Birthdate: ______Age: ______

Note – child care is for children ages 2 - 12 years; limited number of spaces available for 2 year olds.

Parent/Guardian Name (s)

______

Home Address: ______

Home telephone: ______Other telephone: ______

E Mail address: ______

______is a Hagerstown Community College Parent’s Name

Student ID #:______Semester Enrolled: ______

List courses enrolled this semester (day and/or evening): ______, ______, ______, ______, ______Total credits: ______

Please Indicate Days Care is Desired

Evening Block (5:45 – 9:00 pm): ___ Mon. ___ Tues. ___ Wed. ___ Thurs.

Fees and Payment Policies:

$15 per evening per child – students who are enrolled in 3 credits (1 class)

$10 per evening per child – discounted rate for students who are enrolled in 6 credits or more (day or evening classes)

Tuition will be charged for the entire semester, according to the evenings child is enrolled. Tuition must be paid in full for the entire semester prior to the beginning of the semester. This means if you have 1 child and your child is enrolled 1 evening a week the total charge will be $150 for the semester (if you are enrolled in 6 credits or more at HCC). The charge will be $225 for one evening a week if you are only enrolled in 3 credits. Student financial aid (grants/loans) may be used to pay for all or part of child care. You may pay in 3 monthly installments if your total child care bill will be $300 or more.

Evening child care will only be offered if a minimum of 10 children are enrolled per evening. Application fee and tuition will be refunded only if evening care is cancelled due to insufficient enrollment.

Tuition will not be reduced or waived for partial attendance due to illness, family vacation or other reasons.

Return to: Terry Kitchen, Director, Children’s Learning Center

Hagerstown Community College, 11400 Robinwood Drive

Hagerstown, MD 21742

Telephone (301) 790-2800 X 322

FAX (301) 393-3688

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OFFICE USE ONLY

____ Application Fee paid ___ Waiting List ___ Accepted ____ Enrolled

evening care application 02/25/11