REGISTRATION FORM FOR SUMMER SCHOOL 2021 – Hillside School and Learning Center

REGISTRATION FORM FOR SUMMER SCHOOL - 2021

Registration for Summer School 2021

Student's Legal Name: *
First
Last

Gender *
Male
Female

Date of Birth: *

Student's Email *
Please provide a personal email and NOT A SCHOOL EMAIL such as johndoe@lcusd.net

School in Fall 2021: *

Grade in Fall 2021: *

High School Grad Year: *

Has Student Attended Hillside before?
Yes
No

If Yes, what was the last year attended:

If Yes, what was the program? (day school, summer school, tutoring, one-on-one class)

Does student have an IEP or 504? If yes, please include a copy with your registration *
Yes
No

Parents: Do you expect your child to go to college? *
Yes
No

Students: Do you plan to go to college? *
Yes
No

Parent/Guardian #1 Name: *
First
Last

Gender *
Male
Female

Home Phone #:

Cell Phone #: *

Address: *
Address Line 1
Address Line 2
City
State
Zip Code

Parent Email *

Work Phone #:

Company Name:

Position:

Parent/Guardian #2 Name: *
First
Last

Gender *
Male
Female

Home Phone #:

Cell Phone #: *

Address: *
Address Line 1
Address Line 2
City
State
Zip Code

Parent Email: *

Work Phone #:

Company Name:

Position:

If parents have separate addresses: With whom does the child reside?

To whom does the school send paperwork (contract, billing, grades, etc.)?

Summer Session Dates: Mon, June 14, 2021 - Fri, July 23, 2021
A maximum of two classes can be taken during the summer session, unless approved by Hillside Administration.
If a class is waitlisted, please complete this form and administration will be in contact with you if a spot opens.

Course 1

If a class is WAITLISTED, there is a possibility another session will open if there is a demand. So please complete this form so we know. Thank you!

Course 1 Semester(s)
A (June 14-July 2)
B (July 6-July 23)
A & B (June 14-July 23)

Course 2

If a class is WAITLISTED, there is a possibility another session will open if there is a demand. So please complete this form so we know. Thank you!

Course 2 Semester(s)
A (June 14-July 2)
B (July 6-July 23)
A & B (June 14-July 23)

Photo Release: I do/do not grant permission for my child's photo to be used for publicity purposes for The Hillside School & Learning Center. These photos will be used strictly for informational literature (e.g., website, press releases, and brochures). I acknowledge these photos are the sole property of Hillside and no compensation will be received. *
I do give permission
I do not give permission

Student transcripts will be automatically submitted to the student’s home high school unless otherwise advised. I hereby authorize the exchange of any and all pertinent information between The Hillside School and the school listed below. PLEASE SEND FINAL TRANSCRIPTS TO: *

Where did you hear about Hillside Summer School? *

TUITION:
Semester Tuition: One Class: $875, discounted multi-class rate: $850 per class
A non-refundable $200.00 deposit per class is to be paid and received within 7 days from submitting this registration and will be included in your total tuition. YOU MAY MAIL A CHECK OR DROP OFF A CHECK AT THE HILLSIDE SCHOOL. DROP BOX LOCATED AT 4331 OAK GROVE DR. LA CANADA, CA 91011 UPSTAIRS ON THE OUTSIDE NORTH STAIRS. CHECKS MAY BE MAILED TO SAME ADDRESS.
Science lab fee: $75.00 per class
Tuition is to be paid in full by Friday, May 28, 2021. Terms and conditions are below. All invoices will be sent via email unless otherwise requested. A convenience fee of 3.7% will be added to all payments made by credit card. A fee of $35 applies for returned checks. A minimum of 5 students is required for the class to run. If the minimum of 5 students is not met and the class does not run, a full refund will be issued.

Initial Here: *
(I/We have read and understand the tuition and fees.)

TERMS AND CONDITIONS
Receipt of credits is contingent upon:
1. I understand I am not registered for any classes until I submit all paperwork and registration fees to The Hillside School. Enrollment is on a first-serve basis. If the requested class is full, I will be notified by Hillside.
2. If full payment is not received by May 28th, the student will be dropped from the class(es) and the deposit will be forfeited.
3. I understand no refunds will be made after the second day of class. At this time, full tuition will be forfeited.
4. Your spot is being conditionally held for 7 calendar days and if payment is not received, your spot will be forfeited and you will have to reapply. The undersigned agrees to the terms and conditions of enrollment at The Hillside School and of this contract.

Method of Payment *
Pay by Credit Card - I will be calling the school office at 818.790.3044 to pay by credit card. (A 3.7% will be added to all credit card payments.)
Pay by Check - I will be dropping off or mailing a check to: Hillside School, 4331 Oak Grove Dr., La Canada, CA 91011. ($35 fee is charged for any returned check.)

Raffle Tickets to win Summer School Tuition
$5 for one ticket - I will include payment with my deposit.
$20 for five tickets - I will include payment with my deposit.
Raffle winner will receive $675 towards a summer school class for 2021 summer. Drawing will be June 11th, 2021 – winner does not need to be present. (no cash value/non-transferable)

Initial Here: *
(I/We have read, understand and agree to the terms and conditions on this form.)

Additional Comments:

Comment

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