PASSWORD: ___________________
FIRST STEPS INTERNATIONAL ACADEMY
Enrollment Application
PARENT / GUARDIAN INFORMATION
Mother’s or Legal Guardian’s name:_____________________________________
Last First Middle
Address:________________________________________________________________
City State Zip CodeHome Phone Number: (______)________-__________Work Phone: (______)________-__________Mobile Phone: (______)________-__________Name of Employer:____________________________________________ Father’s or Legal Guardian’s name:___________________________________________Last First MiddleAddress: (If different)_____________________________________________________________________
City State Zip CodeHome Phone Number: (_____)________-__________Work Phone: (_____)________-__________Mobile Phone: (_____)________-__________Name of Employer:___________________________________________
Parent’s or Guardian’s marital status: O Married O Single O Divorce O Widowed O Separated
If divorce, who has legal custody of child? (Current letter may be required)
STUDENT INFORMATION
Child’s Name Classroom D.O.B. Sex
Last First Middle
1. ________________________________________________________ __________________ ____/____/____ M / F
2. ________________________________________________________ __________________ ____/____/____ M / F
3. ________________________________________________________ __________________ ____/____/____ M / F
Child’s Physician
_________________________________ __________________________________
(______)______-_______
Name Address City State Phone Number
Hospital Preference: __________________________________________
The closest hospital is Memorial West located on Flamingo Road.
EMERGENCY CONTACTS – PICK UP AUTHORIZATION ( Drivers license copy needed)
Name Home Number Work Number Relationship Driver’s License
1._____________________________ (______)______-__________ (______)______-______ _____________ ________________
2._____________________________ (______)______-__________ (______)______-______ _____________ ________________
3._____________________________ (______)______-__________ (______)______-______ _____________ ________________
4._____________________________ (______)______-__________ (______)______-______ _____________ ________________
5._____________________________ (______)______-__________ (______)______-______ _____________ ________________
______________________________________________ _____/_____/_____
Parent’s or Legal Guardian’s Signature Date

First Steps International Academy
Application for Employment
FSIA is an equal opportunity employer
Name of applicant: ______________________________________________________________
Last First Middle
Address: ______________________________________________________________________
Street Address City State Zip Code
Phone Number: (____) __________________________
In case of emergency, who may we contact?
_____________________________________________________________________________
Name of person Home phone number Work Number Relationship
References: (Person(s) may not be related to you)
1. ___________________________________________________________________________
Name of person Home number Position Work number How long known
2. ___________________________________________________________________________
Name of person Home number Position Work number How long known
3. ___________________________________________________________________________
Name of person Home number Position Work number How long known
Are you a US citizen? ______
Social Security Number _____________________________________
Have you ever been discharged by any company or school? ______ If yes, please state name of company and reason for discharge. ________________________________________________
_____________________________________________________________________________
Have you ever been convicted of a crime other than a minor traffic violation? ______
If yes, explain. _________________________________________________________________
_____________________________________________________________________________
Last physical exam date: _______________ Last TB test date ____________________
Do you have any physical condition that may restrict your performance of the job you are
applying for? __________________________________________________________________________
Job Expectations
Salary expected: $___________ per hour Temporary ______ Permanent _____
Position Desired: ___Aide ____Teacher (Education degree, CDA or equivalent)
Age group preference: (check one or more) __Infants __1 yr. olds __2 yr. olds
__3 yr. olds __Pre-K __After school
___Part time ___ Full time
Working hours preferred: _______ to _______ Total hours per day________
Do you have a CDL? ______

Educational Background:
1. ___________________________________________________________________________
Grammar/Elementary school City/State Dates Attended
2. ___________________________________________________________________________
Middle/Junior High School City/State Dates Attended
3. ___________________________________________________________________________
High School City/State Dates Attended Last grade completed
4. ___________________________________________________________________________
College/University City/State Dates Attended Field of study/degrees earned
5. ___________________________________________________________________________
Post Graduate School City/State Dates Attended Field of study/degrees earned
6. ___________________________________________________________________________
Vocational or other City/State Dates Attended Field of study/Certificate earned
Work Experience: (Please start with most recent employer)
1. ___________________________________________________________________________
Name of Company/School City/State Phone Number Supervisors Name
___________________________________________________________________________
Your Position Salary: Start/End Employment Dates Reason for leaving
2. ___________________________________________________________________________
Name of Company/School City/State Phone Number Supervisors Name
___________________________________________________________________________
Your Position Salary: Start/End Employment Dates Reason for leaving
3. ___________________________________________________________________________
Name of Company/School City/State Phone Number Supervisors Name
___________________________________________________________________________
Your Position Salary: Start/End Employment Dates Reason for leaving
4. ___________________________________________________________________________
Name of Company/School City/State Phone Number Supervisors Name
___________________________________________________________________________
Your Position Salary: Start/End Employment Dates Reason for leaving
Licenses, certificates, or credentials, such as CDA, qualifying you for employment?
_____________________________________________________________________________
Special skills or talents which you may care to list:
Foreign Language _______________________ Swimming Instruction _____________________
Gymnastics ____________________________ Computers _____________________________
Musical Instruments _____________________ Art ____________________________________
Others _______________________________________________________________________
May we contact your former or present employers for references: ___ yes ___ no
_____________________________________________________________________________
Applicant’s Signature Date

FIRST STEPS INTERNATIONAL ACADEMY
Tuition and Fees 2003 - 2004
1. Fees are based on the following:
- Full time program goes from 8:00a.m to 4:00p.m.
- Half day program runs from 8:00a.m. to 12:00 p.m.
- Extended time will be charged extra and run from 7:00a.m. to 6:30p.m.
2. Registration Fee is non-refundable: Full Year Registration: $142
(You receive one School uniform shirt. If you need more, they can be purchased at the School Office)
3. Fees are payable in advance either monthly or weekly. There is a 10% discount that will be applied to additional child’s tuition. A $15.00 late fee will be assessed for any tuition that is overdue or paid after of each week.
4. Meals and snacks are included in full days Tuition.
5. Fees are based on the following:
SCHEDULE * Weekly (W) , Monthly (M)

Two days tuition, from 8 am to 4 pm $125 (W) - $ 520(M)

Three half days tuition, from 8 am to 12 m $120 (W) - $ 500(M)

Three full days tuition, from 8 am to 4 pm $142 (W) - $ 592(M)

Five half days tuition, from 8 am to 12 m $131 (W) - $ 546(M)

Five full days tuition, from 8 am to 4 pm $152 (W) - $ 634(M)


EXTENDED TIMES

8 am to 2 pm ( 3 or 5 days) + $15 per week
7 am to 6:30 pm (2,3 or 5 days) + 15 per week

IMPORTANT NOTICE:
Weekly tuition policy: A full month tuition deposit is require if weekly tuition is selected as the regular payment option.
SCHOOL AGE CHILDREN
Registration Fee is non-refundable: Full Year Registration: $ 135
Enrolled Not-enrolled
Early Release: $ 20.00 $ 25.00
Day Off: $ 40.00 $ 45.00
* Special Classes are charged separately.