REGISTRATION FORM FOR JR HIGH SUMMER REACH FOR SUCCESS



In case of emergency, and if I/we cannot be reached, I/we the undersigned parent(s) or guardian(s) of the above named student, a minor, do hereby authorize a representative of The Hillside School and Learning Center and/or the alternates listed above to act as agent(s) to consent to any X-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care deemed advisable and rendered by any licensed physician or surgeon, whether in his/her office or in a licensed hospital. This authorization is given in advance of any required care to empower a representative or official of the The Hillside School and Learning Center to give consent for such treatment as the physician may deem advisable. I/we understand that The Hillside School and Learning Center does not provide accident medical insurance for students for school-related injuries.

TUITION:
Semester Tuition:
$725
A non-refundable $200.00 deposit per class will be kept if you drop a class for any reason. No refunds will be given after the 1st day of class.
Tuition is to be paid in full within 5 business days of registration. Terms and conditions are below. A convenience fee of 3.7% will be added to all payments made by credit card. A fee of $35 applies for returned checks.

(I/We have read and understand the tuition and fees.)
(I/We have read, understand and agree to the terms and conditions on this form.)

 

THE HILLSIDE SCHOOL AND LEARNING CENTER IS FEDERALLY RECOGNIZED AS A 501(C)(3) TAX EXEMPT ORGANIZATION.