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