Enrollment Form 2008/ IMPORTANT only fill this form out if you have been enrolled through the office
Please click on the Submit button to submit the form details.
*
indicates required fields
*
Mother and Father NAME:
*
Address (include city and Zip):
*
Cell Phone:
*
Home Phone:
*
email:
*
Student name:
*
Date of birth:
*
Class day/time:
*
Pool location:
Pool #1
Pool #2
Pool #3
Student name:
Date of birth:
Class day/time:
Pool location:
Pool #1
Pool #2
Pool #3
Start date:
Winter Session 2009
Spring Session 2009
Summer Session 2009
Fall Session 2009
*
Credit Card visa/MC:
Visa Card
Master Card
*
Credit Card number:
*
Exp Date:
*
Billing Address:
*
Name on Card:
*
I have read and agree to the following policies:
Session/Tuition dates
School Policies
Makeup Policy
Drop Policy
Auto pay Policy
Release of Liability
*
Signature:
*
TUITION AMOUNT:
$325.00 plus enrollment fee/ 3 month tuition
$115.00 3 installment payments plus enrollment fee/auto monthly
TWO students $640.00 plus $45.00 enrollment fee for two
TWO students $226.00/ 3 installment payments plus $45.00 enrollment fee for two
PRO RATED AMOUNT
ADDED NOTES:
Please click on the Submit button to submit the form details.
littledipperswimschool@yahoo.com
(925) 932-5861 office line (925) 932-5329 fax line
Site Map
