Document

For enrollment, you will be initially charged the following fees:

Deposit: $ 250.00

Annual Registration Fee: $ 120.00

Annual Material Fee: $ 140.00

Total: $ 510.00

Unless you start at the beginning of the month, your first month's tuition fee will be prorated based on your first day of attendance. The first month tuition will be charged one week before the first-day of attendance.

Referral code, if avail.

STUDENT INFORMATION

First name*

Last name*

Birthday*

Age

Gender*
Male Female

School Attending*

Grade (In Sept of this years)*

Room (Only required for Kinder)

Pickup need*
Yes No

If yes, school dismiss time

Short Day

Short Day Dismissal Time

Starting date*

Please select all the day you wish to attend*
Mon Tue Wes Thu Fri

FAMILY INFORMATION

Home Address Line1*

City*

State*

Zip*

Father's First Name*

Last Name*

Cell*

Email Address*

Employer Name

Please reconfirm your email address and make sure they are the same:

Email Address*

Mother's First Name*

Last Name*

Cell*

Email Address*

Employer Name

Please reconfirm your email address and make sure they are the same:

Email Address*

OTHER INFORMATION

Emergency contact

Phone

Physician (name and address)

Phone

Dentist (name and address)

Phone

Allergies (if any)

PAYMENT INFORMATION

We do collection via ACH-autopay. Please fill out the following Payment Method: ❔

Routing Number (9 digits)*

Account Number (6-18 digits)*

Please reconfirm these two fields and make sure they are the same:

Routing Number*

Account Number*

Bank Name*

Name on Bank Account*

Account Holder Phone*

After School Program

STUDENT INFORMATION

FAMILY INFORMATION

OTHER INFORMATION

PAYMENT INFORMATION