After School Program Application
Applicant Information (attach a small photo - optional)
Student Name: First/Middle/Last
Name Called
Current School/School Address
Application for Admission to After School Program for academic year 20- /20-
Male Female Date of Birth
How did you learn about the Little Da Vinci International School?
Applicant’s Address
Street Address
City/State/Zip Preferred Phone ( )
Who lives with the student at this address? Check all that apply:
Father Mother Stepfather Stepmother Other
Parents are: Check all that apply: Married Divorced Widowed Separated Other
Family Information: Please provide information about family with whom student resides:
Parent or Guardian: Dr. Mr. Mrs. Ms. Parent or Guardian: Dr. Mr. Mrs. Ms.
Name in Full Name in Full
Preferred Name Preferred Name
Relationship to Student Relationship to Student
Cell/Mobile Phone Cell/Mobile Phone
Email Address Email Address
Employer Employer
Occupation/Title Occupation/Title
Person authorized to pick up your child:
Name Name
Relation to Student Relation to Student
Address Address
Preferred Phone Preferred Phone
4055 Roswell Rd., Atlanta, GA 30328 • 404-434-9078 • www.littledavincischool.org
The Little Da Vinci International School is a nonprofit community oriented preschool. The Little Da Vinci International School does not discriminate on the basis of race,
color, sex, religion, national origin, age, or disability in any employment practice, educational program or any other program, activity, or service.
Family information continued
Family Information:
Please give the names, current grade and current school for all siblings:
Name Current Grade Current School
Name Current Grade Current School
Name Current Grade Current School
Are any siblings currently applying to Little Da Vinci International School? Yes No
Why do you believe that Little Da Vinci International School will be a good educational environment for your child?
(A separate sheet may be attached.)
In a short paragraph, please tell us more about your child, including, strengths, weaknesses, and other characteristics.
Is this child taking any attention-facilitating medication? Yes No
If yes, please name medication.
Signature of Parent or Guardian: Date:
This application is complete to the best of my knowledge.
Optional Information:
If you wish to be identified with a particular ethnic group, how would you identify yourself?
African American Latino/Hispanic Asian American
Native American Middle Eastern American European American
Multi-racial American Pacific Islander American Other (specify)
4055 Roswell Rd., Atlanta, GA 30328 • 404-434-9078 • www.littledavincischool.org
The Little Da Vinci International School is a nonprofit community oriented preschool. The Little Da Vinci International School does not discriminate on the basis of race,
color, sex, religion, national origin, age, or disability in any employment practice, educational program or any other program, activity, or service.
Classes and Tuition:
Without Transportation With Transportation with an additional 20% of the monthly fees
SCHEDULE A (2:45 pm – 6 pm) 1H 1/2 Enrichment Program & 1H 3/4 After School Program
A1 (5 days)……………………………M-F $590
A2 (4 days)………circle 4: M T W Th F $475
A3 (3 days)…………………………M W F $360
A4 (2 days)………………………… T Th $255
A5 (1 day)……… circle 1: M T W Th F $180
SCHEDULE B (3 pm – 4:30 pm) 1H 1/2 Enrichment Program
B1 (5 days)……………………………M-F $330
B2 (4 days)………circle 4: M T W Th F $280
B3 (3 days)…………………………M W F $220
B4 (2 days)………………………… T Th $180
B5 (1 day)……… circle 1: M T W Th F $130
SCHEDULE C (4:45 pm – 6:15 pm) 1H 1/2 Enrichment Program Middle School
C3 (3 days)…………………………M W F $245
C4 (2 days)………………………… T Th $195
C5 (1 day)……… circle 1: M T W Th F $150
CLASSES
Language Classes: French Spanish Mandarin
Mathemagic
L’atelier d’Art: Artitude Artrageous
Environmental education and Biology
Ecosystem discovery
Physics
An Enrollment/orientation packet will be sent to you as confirmation of your child’s enrollment.
A non refundable $75 enrollment fee is due with the return of your child’s completed paperwork
Name of the Parent/Guardian (Please Print) Signature of Parent/Guardian Date
Name of the Parent/Guardian (Please Print) Signature of Parent/Guardian Date
4055 Roswell Rd., Atlanta, GA 30328 • 404-434-9078 • www.littledavincischool.org
The Little Da Vinci International School is a nonprofit community oriented preschool. The Little Da Vinci International School does not discriminate on the basis of race,
color, sex, religion, national origin, age, or disability in any employment practice, educational program or any other program, activity, or service.