Lilli’s Enrollment Form

Miss Lilli’s Registration & Contract

First Semester:

Sept. 9, 2019 – January 13, 2020

Parent/Guardian ________________________________________________________________________

Student (s) ___________________________________________Date of Birth _____________________

Address ________________________________________________________________________________

City/State/Zip _________________________________________________________________________

Home phone ___________________________ Cell phone ________________________________

Parent’s e-mail ________________________________________________________________________

Circle the names of the classes your children are taking and

write each child’s name next to the intended class:

SEMESTER

CLASS PRICE CHARTER PRICE

IEW Writing, Ancient History Theme $200 $225

Meets Mondays 9:00-10:00 (60 mins/wk)

IEW Writing, Medieval Theme $200 $225

Meets Mondays 10:00-11:15 ( 75 mins/wk )

First Form Latin, $200 $225

Meets Mondays 11:30-12:30 (60 mins/wk,)

British Literature, $200 $225

Meets Mondays 12:30-1:30 p.m. (60 mins/wk,)

Plus a one time non-refundable registration fee of $25 per student.

Registration fee is waived for those registering and paying entire

first semester tuition prior to August.

Sub Total Class Fees for semester: _______________________________________

For charter school students to be considered registered, the registration form and non-refundable registration fee of $25 per student must be submitted.

Students dropping the course after registration and payment and prior to the start of the course, can expect to receive a refund, minus a $25 administration fee.

Students wishing to drop after the fourth week of class will not receive a refund.

Parents of charter school students are ultimately responsible for the tuition in the event that the charter school refuses to pay.

If you wish to pay by credit card you may do so on the first day of class; however, be aware that there is an added 4% processing fee.

If you would like to make payments: Family Payment Plan spread over 4 months, add $20 billing fee.

Sub Total __________________

Registation Fee: ___________________ $25.00 Per Student

Credit Card Fee (if used) 4% _________________ (Total X .04)

Family Pay Plan Fee __________________ ($20.00 Billing Fee if used)

Total Fee _________________

I ____________________________________ (parent’s name) commit to paying:____________________

For a Payment plan, divide your total into 4 equal payments.

Office Use Only

$____________ in September Received: _______________

$ _____________in October Received: _______________

$_____________ in November Received: _______________

$_____________ in December Received: _______________

Make checks payable to:

Lilli Witczak

679 W. Sierra Madre Blvd.

Sierra Madre, CA 91024