PRESCHOOL ***Dark gray areas to be filled

REGISTRATION FORM out by registration office.***

(Please Print)

STEP 1: FAMILY INFORMATION *Registered by: ____________ Date: _________________

PLEASE INDICATE CLASS DESIRED(ASSIGNMENTS ARE BASED ON AVAILABILTY, REQUESTS ARE NOT GUARENTEED)
MON, WED, FRI _____AM _____PM TUE, THURS _____AM _____PM
Parent’s Last Name: First: Middle:  Mr.  Miss Email Address:
 Mrs.  Ms.

Street Address: Subdivision: Primary Phone:

( )
City: State: Zip: Secondary Phone:
( )

How did you hear about us? (please check one box):  Friend/Neighbor  Postcard  Newspaper  Banner  City Event  Web

 Other (specify): __________________________________________ Referred by: ____________________________________________

Emergency Contact (not living at same address): Relationship to family: Home phone no.: Work phone no.:
( ) ( )

( ) ( )

STEP 2: CHILDS INFORMATION

# Childs Name: Birth Date: Age: Sex: Comments/Allergies:

1 / / M F

INSTRUCTIONS FOR NEXT STEPS: CLASS ENROLLMENT AND PAYMENT- MAKE CHECKS PAYABLE TO LIL’
SCHOLARS ACADEMY LLC FOR ALL FEES AND DUES
1 Enrollment- Monthly tuition is $85 per month for Mon, Wed, Fri classes and $75 per month for Tue, Thurs classes
2 Registration Fees - $25.00 non-refundable*
3 Sign and Date the Agreement
4 Review with Receptionist and Pay Registration Fees
STEP 3: ENROLLMENT
Child’s Name: (from #2 above) *Registration Fee: Monthly Amount:

Other Fees

Discounts

Total 1) 2)

*Registration fee is $25. Early registration has a discount of $10. Late Registration has a fee of $10. Check the website
www.lilscholarsacademy.net for registration dates.

STEP 4: INITIAL PAYMENT/REGISTRATION FEE *Check #: _____________

STEP 5: CONTINUING DUES PAYMENT AGREEMENT Monthly Amount: $_____________ Initials______

Please return document in person or mail to 1750 Homedale Road Klamath Falls Or 97603. Call 273-2219 or
email sara@lilscholarsacademy.net with questions.
STEP6: MONTHLY POST DATED CHECKS FOR DURATION OF TERM
Sign and post date one check for each month of the remainder of the term in the amount of the total monthly tuition from step#2
above. Checks should be dated on or before the 5th of each month.
STEP 7: ACKNOWLEDGEMENT OF BINDING AGREEMENT

Yes. Please register my child for preschool. I also agree to abide by the following policies:
 I agree to pay my tuition payment(s) by the 5th day of each month. I understand that payments received after the 5th
day of the month will be charged a $10 late fee and all fees associated with a bounced check.
 I understand that my registration fee is non-refundable.
 I am registering my child for the full term and agree to pay a $50 early withdrawal fee should I chose to cancel my
student’s enrollment.
 Teachers and class times are subject to change.
 Lil’ Scholars Academy reserves the right to cancel services at anytime for any reason. In event of cancelation, pro-
rated refunds will be individually assessed.
I have read, understand and agree to abide by the binding terms of this agreement.

Signature of Parent or Legal Guardian: ____________________________________ Date: / /

Remember to include a check for the registration fee

and post dated checks (first of each month) for tuition.