ENROLLMENT FORM

* Required Fields

Student Information

First Name * :

MI :

Last Name * :

Mailing Address * :

City * :

State * :

Zip Code * :

School Attending * :

Grade (Current/Rising) * :

Phone (H) * :

Cell :

Email :


Parent / Guardian Information		Emergency Contact
Name * :		Name * :
Cell * :		Cell * :
Email * :		Relationship * :

Program Selection

Program Name *

Plan Selection *

Location *

Schedule Day *

How did you hear about us? *

Student's start Date

Tuition Fee Payment Policy

Current month tuition is due by 7th of the month beyond which, a late payment fee of $15 shall be charged per each month of delay. One month's tuition will be collected at enrollment time as a refundable deposit. One month advance notice is required for any withdrawal. Shorter notice will result in a prorated refund of the deposit amount. Returned checks will be charged $35 extra.

Yes, I have read and accepted the tuition fee policy.