Online RegistrationThis registration form will go directly to the office and you will be contacted and billed for the registration cost. Student InformationChild's Legal Name First Middle Last Name your child prefers (if different than above) Gender Male Female Date of Birth MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneGrade Entering Health/Medical/Educational Needs: (Allergies, Special Medication, Learning Disabilities, ADD/ADHD, or Speech/Language Delay, etc.) If yes, please explain.Parent/Guardian InformationMother's Name First Last Employer Employer PhoneCell PhoneHome PhoneEmail Address Father's Name First Last Employer Employer PhoneCell PhoneHome PhoneEmail Address Primary Contact First Last Emergency Contact Information (if parents cannot be reached)Name First Last NumberRelationship to Student Name First Last NumberRelationship to Student Name First Last NumberRelationship to Student Please Check One:PreschoolK-3 Program (Registration $350) 3 and potty trained by September 1st 9 Month Payment Plan $500.00 10 Month Payment Plan $450.00 11 Month Payment Plan $409.00 Mon-Friday Class 8:15-3:00K-4 Program (Registration $350) 4 by September 1st 9 Month Payment Plan $500.00 10 Month Payment Plan $450.00 11 Month Payment Plan $409.00 Mon-Friday Class 8:15-3:00K-5 Program (Registration $350.00) 5 by September 1st 9 Month Payment Plan $550.00 10 Month Payment Plan $495.00 11 Month Payment Plan $450.00 Mon-Friday Class 8:15-3:00Elementary1st Grade (Registration $350.00) 9 Month Payment Plan $550.00 10 Month Payment Plan $495.00 11 Month Payment Plan $450.00 2nd Grade (Registration $350.00) 9 Month Payment Plan $550.00 10 Month Payment Plan $495.00 11 Month Payment Plan $450.00 3rd Grade (Registration $350.00) 9 Month Payment Plan $550.00 10 Month Payment Plan $495.00 11 Month Payment Plan $450.00 4th Grade (Registration $350.00) 9 Month Payment Plan $550.00 10 Month Payment Plan $495.00 11 Month Payment Plan $450.00 5th Grade (Registration $350.00) 9 Month Payment Plan $550.00 10 Month Payment Plan $495.00 11 Month Payment Plan $450.00 Additions 7:30-5:30 Students additional monthly charge of $70.00. Drop-in rates for Excel is $10.00 a day. If you will be utilizing our before and/or after-school programs, please fill in approximate days/times you will need. The before-school program is available daily, Monday-Friday 7:30 a.m. to 8:10 a.m. The after-school program is available daily, Monday - Friday 3:00 p.m. to 5:30 p.m.Monday's ArrivalMonday's DepartureTuesday's ArrivalTuesday's DepartureWednesday's ArrivalWednesday's DepartureThursday's ArrivalThursday's DepartureFriday's ArrivalFriday's Departure Add RemoveSee example: Mondays Arrival: 7:45 a.m. Departure: 4:45 p.m.People authorized to pick up my child/children Add RemoveFinancial InformationStudent's Name and Grade Add RemoveTuitionPlease check the appropriate box for your tuition payment plan. Pay in full (9-month tuition paid in full) 9-month plan (monthly payments beginning: Sept. 1 and end May 30 of next year) 10-month plan (monthly payments beginning: Aug. 1, and end May 30 of next year) 11-month plan (monthly payments beginning: July 1, and end May 30 of next year) Tuition AssistanceIf you will be asking for tuition assistance, please stop by the school office and pick up a tuition assistance request form. Please note tuition assistance request forms must be returned to the office by May 30th.Parent Signature and Date(Required) How did you hear about CCS? (Family, friends, newspaper, internet, etc.) Why are you seeking enrollment at CCS? PhoneThis field is for validation purposes and should be left unchanged.
