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| EIE ACADEMY RENEWAL 2007-08 SCHOOL YEAR If you currently enrolled with EIE Academy and wish to renew for the 2006-07 school year, please fill out this form and send with payment to EIE. Family Last Name: __________________________________ Father’s First Name: _________________________ Mother’s First Name: _______________________________ Address: _________________________________ City: _____________________ State: _____ ZIP _________ Phone Number: ______________________________ E-Mail Address: _________________________________ (Please be sure to include your e-mail address so we can e-mail important notices in a timely manner.) Please list names of children enrolling for the 2006-07 school year. If last name of child is different please indicate this on name line. Name: ________________________________________________________ DOB: ___________ Grade: _______ Name: ________________________________________________________ DOB: ___________ Grade: _______ Name: ________________________________________________________ DOB: ___________ Grade: _______ Name: ________________________________________________________ DOB: ___________ Grade: _______ Name: ________________________________________________________ DOB: ___________ Grade: _______ Name: ________________________________________________________ DOB: ___________ Grade: _______ The tuition for the 2007-08 school year will be $275.00. If you are adding a new student add $20.00 per student. All high school students are assessed a $35.00 surcharge as well. We accept credit cards, checks and if you pay in the store we accept cash. After seven days from renewal there are no refunds for tuition or fees. Credit Card Number: _____________________________________ Expiration Date________ CCV _________ (CCV Code is the three numbers you will find on the back of your credit card following the credit card number or the four numbers on your American Express Card.) Payment Work Sheet: Tuition: $275.00 Registration Fee for new students only: (20.00 per student) ________ (Maximum of $40.00 per family) High School Sur-Charge ($35.00 per high school student) ________ Payment Plan Fee* ($35.00) ________ Total Fee’s Due ________ Amount Paid ________ Balance Due ________ *Payment option: If you wish to make payments for your tuition we will require a credit card number so we can make monthly charges or five pre-dated checks for the payments. A minimum of a 25% downpayment is required and the balance paid within five payments. We charge a convenience fee of $35.00 if you use this option. Mail this enrollment form and course of study to: EIE Academy 2640-A7 S. Myrtle Ave. Monrovia, CA 91016 ************************************************************************************************************** Office Use Only: Date Received: _______________ Payment: _________________ Type: ________________ |
| RENEWAL FORM |