Miss Lilli’s Registration & Contract

First Semester: 

September 13, 2021 – January 10, 2022



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                                                                                                         CHARTER PRICE             



Forbidden Fruit, 60 mins/wk,                                                                         $275.00

$250.00 per semester   Meets Mondays 8:30 – 9:30


The President’s 1776 Report, 60 mins/wk, $250 per semester              $275.00

Meets Mondays 9:30 – 10:30


First Form Latin , 60 mins/wk, $250.00 per semester                                $275.00

Meets Mondays 10:30 – 11:30


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