Miss Lilli’s Registration & Contract

First Semester:  Sept. 13, 2021 – January 10, 2022


Parent/Guardian ________________________________________________


Student      _____________________________Date of Birth ____________


Student      _____________________________Date of Birth ____________


Student (s) _____________________________Date of Birth ____________


Address __________________________________________________________

City/State/Zip   ___________________________________________________

Home phone   _________________  Cell phone  _____________________

Parent’s e-mail ____________PPP____________________________________


Circle the names of the classes your children are taking and write each child’s name next to the intended class:                        Charter Price:

First Form Latin, 60 mins/wk, $250 per semester                                                                                                                                               $275

Meets Mondays 10:30-11:30


Forbidden Fruit, 60 mins/wk, $250 per sem                                                                                                                                                         $275

Meets Mondays 8:30-9:30


The President’s 1776 Report, 60 min/wk, $250 per sem                                                                                                                                     $275

Meets Mondays 9:30-10:30

Total class fees for first semester:   ________

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.

Family Payment Plan spread over 4 months, add $15 billing fee   +____      $15 billing fee


Total Due ____________


Continues on next page.

For payment plan:


I  _______________________________  (parent’s name) commit to paying:_____________________


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

$________  in September

$ ________ in October

$________ in November

$________ in December


Make all checks payable to:

Lilli Witczak

679 W. Sierra Madre Blvd.

Sierra Madre, CA 91024