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Welcome to LIMS Academy! 

LIMS Academy accepts students of any race, national and ethnic origin or religion. The academy does not discriminate on the basis of ethnic or national origin. LIMS Academy welcomes children beginning at age two and continuing through the age of six. The admissions are open throughout the year and accepts applications on an ongoing basis. 

LIMS Academy Enrollment Form

Child’s Full Name: ____________________________________ Date: __________




City: ____________________ State: ______ Zip code: _______________________


Child’s age: ______________ Child’s Birthday: _____________________________


Mother’s Name:



Father’s Name: _______________________________________________________


Mother’s Home Phone: ____________________ Cell Phone: __________________


Mother’s Work Phone: _____________________


Father’s Home Phone: ____________________Cell Phone: ____________________


Father’s Work Phone: _____________________


Emergency Contact Person:


Relation: _________________________Contact Phone: _______________________


Emergency Contact Person:


Relation: _______________________ Contact Phone: ________________________


CHILD’S HEALTH RECORD: (A copy of your child’s immunization form and current physical will be needed)


General state of health: __________________________________________________


Doctor’s Name: _______________________Doctor’s phone: ___________________


Dentist Name: ________________________ Dentist phone: ____________________


Are your child’s immunizations up to date? _________________ (Please provide the school with appropriate immunization forms by August 15.


Does your child have any allergies? _________________________________________


Emergency Authorization: I give permission for the school to obtain emergency medical treatment, including emergency transportation, for my child if I cannot be reached immediately. I agree to be responsible for any emergency medical expenses incurred. (If parent/guardian refuses to sign, instructions must be attached stating what procedure the facility is to follow in case of emergency.)

_____________________________________________ __________________________

Signature Date




Has your child ever been in any school or daycare? ________________________________________________________________________


Describe your child’s personality and interests? ________________________________________________________________________




Is your child potty trained? __________________________________________________


Are there any other comments/concerns or information you would like to let me know










Tuition is due each month: Pricing

Age: 2/3K: $350.00

Age: 4/5/6K: $350.00


Please complete and sign your contract and return it with the enrollment packet.

Enrollment fees: The enrollment fee of $ 150.00 is required at the time of registration to secure your child’s place.

Checks should be made out to LIMS Academy


Section A


I hereby accept the place offered to my child _________________________, at LIMS Academy.


Section B

Tuition is due on the 10th of the each month and considered late by the 11th of each month.

______(Initial) I have read and agree to the information above and understand that my

enrollment fee is non-refundable.

______________________________ ___________________________________


Father’s Signature Mother’s Signature


Authorized Signature: _____________________________________