Miss Lilli’s Registration & Contract
First Semester:
September 14, 2020 – January 13, 2021
Parent/Guardian ________________________________________________________________________
Student (s) ___________________________________________Date of Birth _____________________
Student (s) ___________________________________________Date of Birth _____________________
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 CHARTER PRICE
IEW Writing, Fables, Myths, and Fairy Tales Theme, 60 mins/wk, $250
$225 per sem Meets Mondays 9:00-10:00
IEW Writing, U.S. Theme, 75 mins/wk, $225 per sem $250
Meets Mondays 10:00-11:15
Latin I, 60 mins/wk, $225 per semester $250
Meets Mondays 11:30-12:30
Writing for the Reluctant, 60 mins/wk, $250 per semester $275
Meets Mondays 12:30-1:30 p.m.
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 deposit 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