EIE ACADEMY 2017-18 EARLY BIRD RENEWAL
FAMILY LAST NAME: ______________________________________________________________ DATE: _______________________
FATHER’S FIRST NAME: __________________________________ MOTHER’S FIRST NAME: ________________________________
STREET ADDRESS: ____________________________________________________________________________________________
CITY: _________________________________________________ STATE: ___________________ZIP CODE: ___________________
HOME PHONE: __________________________________ CELL PHONE: ________________________________________________
EMAIL ADDRESS: _____________________________________________________________________________________________
(Please provide your email address since we are now utilizing electronic newsletters and email notifications.)
CHILDREN TO BE ENROLLED FOR 2017-18
FIRST NAME OF CHILD LAST NAME OF CHILD BIRTHDAY GRADE
_____________________________ ____________________________ _____________ ______
_____________________________ ____________________________ _____________ ______
_____________________________ ____________________________ _____________ ______
_____________________________ ____________________________ _____________ ______
If you are enrolling new students please send both health records and the name and address of previous school.
EARLY BIRD TUITION SCHEDULE
IF PAID BY: TUITION DUE SAVINGS
APRIL 15 $250.00 $100.00
MAY 15 $275.00 75.00
JUNE 15 $300.00 50.00
JULY 15 $325.00 25.00
AFTER JULY 15 $350.00 0
Notes: 1. Payment must be made in full. No payment plans. 2. There are no refunds after five days from receipt of renewal. 3. Add $40.00 per high school student (maximum $80.00 per family). 4. You must have paid last year’s tuition in full to participate in the early bird special. Our records indicate you owe ____________from last year.
PAYMENT WORKSHEET PAYMENT OPTIONS
Tuition _____________ CHECKS: CHECK NUMBER: _______________
High School Fee: _____________ CASH: Can use cash option only at EIE Resource Center
TOTAL DUE: ______________ CREDIT CARD NUMBER: _________________________________________________
EXPIRATION DATE: ____________________ SECURITY CODE ______________
FINE PRINT SECTION: We understand that we, the parents, are the sole provider of education to our children. EIE will provide counseling, administrative services and other activities and services to each family. EIE is not responsible for the educational success of the child and EIE is not accredited.
SIGNATURE SECTION:
FATHER: ___________________________________________ MOTHER: _________________________________________________