REGISTRATION FORM FOR SUMMER SCHOOL 2022 – Hillside School and Learning Center

REGISTRATION FORM FOR SUMMER SCHOOL - 2022

Registration for Summer School 2022 - June 15th- last day to sign up for 1st semester classes, July 1st - last day to sign up for 2nd semester classes

Student's Legal Name: *
First
Last

Gender *
Male
Female
Non-binary

Grade in Fall 2022: *

Date of Birth: *

Parent/Guardian #1 Name: *
First
Last

Relationship *

Lives with student primarily? *
Yes
No

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

Parent/Guardian #1 Email *

Primary Telephone Number: *

Cell Phone #: *

Parent/Guardian #2 Name: *
First
Last

Relationship *

Lives with student primarily? *
Yes
No

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

Parent/Guardian #2 Email: *

Primary Telephone Number: *

Cell Phone #: *

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

School in Fall 2022: *

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

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

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)

Summer Session Dates: Mon, June 13, 2022 - Fri, July 15, 2022 --- (June 15th- last day to sign up for 1st semester classes, July 1st - last day to sign up for 2nd semester classes)
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 - Semester 1 (June 13-June 28)
B - Semester 2 (June 29-July 15)
A & B - Semester 1 & 2 (June 13-July 15)

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 - Semester 1 (June 13-June 28)
B - Semester 2 (June 29-July 15)
A & B - Semester 1 & 2 (June 13-July 15)

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: $950, discounted multi-class rate: $925 per class
Full payment is to be paid by the next business day. $200 of the class tuition is a non-refundable deposit in the event you drop the class before the start of the session. YOU MAY CALL 818-790-3044 TO PAY BY CREDIT CARD 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.
Science lab fee: $75.00 per class
Tuition is to be paid by the next business day. 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. A minimum of 5 students is required for the class to run. If the minimum of 5 students is not met by June 3rd, 2022, 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 the next business day, 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 first day of class. At this time, full tuition will be forfeited.
4. Your spot is being conditionally held until the end of the next business day and if payment is not received, your spot will be forfeited and you will have to reapply.
5. Any in-person class may change to an online class. 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 a check at The Hillside School, 4331 Oak Grove Dr., La Canada, CA 91011. ($35 fee is charged for any returned check.)
Registration made during Hillside's Spring Break (April 1-10th) will be due on Monday, April 11th.

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

Additional Comments:

Name

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