MAAP
9211 Arlington Boulevard
Fairfax, VA 22031
Tel: 703-273-8000
Fax: 703-591-1431
Merritt Academy’s After School Program
Application
2015/2016
www.merrittacademy.org
STUDENT INFORMATION
Child’s Name
Last:
Child’s Date of Birth
First:
MI:
Student’s Base School
Grade Level 2014-2015
MM/DD/YY
Start Date
 Sibling of a Current
MAAP/Merritt Student
 Returning Merritt/MAAP
student
FINANCIAL RESPONSIBLE PARTY (All account questions will be directed to this individual.)
Name
Last:
Street Address
Telephone Numbers
First:
City
MI:
State
-
-
Home:
-
-
Cell:
E-mail Address
-
Zip Code
Relationship to Child
MERRITT ACADEMY AFTER SCHOOL PROGRAM
1 Payment for 1 year program
Work:
PROGRAM INCLUDES TRANSPORTATION FROM THE STUDENT’S BASE SCHOOL, DAILY SNACKS AND THE HOURS
OF MONDAYS – FRIDAYS 3:30 – 6:30 PM.
Includes 2% one payment discount
10 Installments

$ 3298.00

$336.00
CONTRACT ACKNOWLEDGMENTS
Completion of this application does not indicate enrollment into the MAAP program. Families will be notified of
acceptance after applications are received.
 Annual Materials Fee of $50.00 must be submitted when child becomes enrolled in MAAP. The Materials Fee is nonrefundable and constitutes a good faith consideration to bind this contract. In case of cancellation, this payment will
become your penalty.
 The August 1, 2015 charge will cover services for the last month of the contract. All other charges will pay current months as they
become due. In the event of early withdraw, the August 1 deposit is forfeited and applied to the early termination penalty, equal
to one month tuition, for any student that is withdrawn prior to the end of the contract term.
 Fees are the same every month regardless of the number of program days in each month.
 Winter and spring break will be signed up for online, with a deadline to follow.
 The school has the right to terminate the attendance of any student for reasons set forth in the Parent Handbook, including
the failure of parents to pay all of their financial obligations.
 There will be an $85 late fee for any payments received after the 5th of each month.
 Thirty (30) days prior written notice is required for cancelling services for the school year, winter or spring programs.
Your account will be billed for fees during the 30 days regardless of attendance. Parents will continue to be billed, and
are responsible for payment unless written cancellation has been received 30 days prior to services ending.
 There is no reduction in the fees for absences due to illnesses and/or vacation and/or inclement weather.
 Enrollment is limited to the 2015-2016 year.
 Any changes/modifications to this contract must be made in writing and authorized by the Executive Director or
MAAP Coordinator.
 A Service fee of $25 will be assessed for each change made to this contract after submission.
I agree to these contract acknowledgments in exchange for the enrollment of my child.

Signature of Parent/Guardian
Social Security Number
Date