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Young Leaders Bilingual Academy
Spring 2010 Pilot Program
Registration open to PreK 4 and PreK 5 |
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Class Calendar January 5-May 25*
*(no classes on 3/30, 3/31, 4/1, 4/2)
Days & Time
Pre K 3; Tuesday - Friday 9:00-1:00
Pre K 4: Tuesday - Friday 9:00-1:00
Registration fee: $100
Pre K 3 $1920
Pre K 4 $1920
Pre K 5 $1920 NAME OF CHILD: AGE: DOB:________
NAME OF PARENT:___________________________________________________________________
HOME ADDRESS:____________________________________________________________________
HOME PHONE:_______________________________________________________________________
CELL PHONE (MOM):__________________________________________________________________
CELL PHONE (DAD):__________________________________________________________________
ALLERGIES:_________________________________________________________________________
PEDIATRICIAN: PHONE:_________________________________________
Emergency contact:_________________________________Phone:_________________________
Email address:____________________________________________________________________
We will confirm your registration via email. Email addresses are kept confidential.
AutoPay (tuition is broken down into equal monthly payments) I would like to sign up for AutoPay and have my credit card charged on the 1st of each month. I understand that in order to cancel Autopayment, I must call the billing center at 630-377-8794 630-377-8794 before the 1st day of the month.
_____________________________________________
(signature)
credit card information is kept confidential and only viewed by company owner.
Credit Card Payment Visa:____ Mastercard:_____
Cardholder:______________________Card number:______________________Exp. date: _______
Signature:___________________________________________Amount:____________or Autopay
Security Code (the three digit code on the back of your card) ______________________
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