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:                  


CLASS                                                                                       PRICE              CHARTER PRICE

 IEW Writing,  Fables, Myths & Fairy Tales                     $225                      $250

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

 IEW Writing, U.S. Theme                                                    $225                      $250

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

 First Form Latin,                                                                   $225                      $250

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

 Writing For The Reluctant Writer                                   $225                      $250

 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