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Futurelink Summer School Registration Form Registration Date ________

Student’s Name _____________________________________________________________ Public School _______________________________________________________________ Grade in Fall 2013 ___________________________

Home Address ______________________________________________________________

Mother’s Name ______________________________________________________________ Mother’s Cell Number _______________________________________________________ Mother’s Work Number ______________________________________________________ Mother’s E-mail Address _____________________________________________________

Father’s Name ______________________________________________________________ Father’s Cell Number ________________________________________________________ Father’s Work Number ______________________________________________________ Father’s E-mail Address _____________________________________________________

Emergency contact if parent or guardian is unavailable __________________________ Emergency Contact Phone Number ____________________________________________ Please list all special medical conditions, allergies, or restrictions ________________ ____________________________________________________________________________

22 W. Live Oak Ave. Arcadia, CA 91007 | Phone (626)446-3333 | Fax (626)446-0013 | Tax ID 95-4438507


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Futurelink Summer School Admission Agreement

Parents, please initial each section: Registration Fee and Sibling Discount

A non-refundable $30 registration fee per student is required with registration for all new students. (Note: only one registration fee per family). Siblings receive a 10% discount.

Tuition Fee Policies

Parent(s) agree to pay the tuition regardless of the child’s attendance during the summer term. No vacation, sick day, or no-show tuition credits will be offered for shortterm absences (absences of less than five consecutive days). Refunds are not given after enrollment.

Late Pick Up Fees

Parent(s) agree to pay a late fee of $10.00 for every half-hour after 6:30 pm that they are late picking up their child.

Field Trip Fees

Fees for additional activities, field trips, etc. are separate. You will be notified of these fees when applicable.

Grounds for Dismissal

Futurelink School retains the right to dismiss any student for unsatisfactory conduct on campus or off campus. The delinquency of tuition or any other school fees shall also be grounds for dismissal. Futurelink reserves the right to terminate enrollment if a student, parent, or guardian does not comply with Futurelink policies, rules, or regulations. Futurelink School may also terminate enrollment if the student, parent, or guardian fails to cooperate with faculty and administration. Repeated violation of Futurelink School rules will result in expulsion without refund.

Medical Authorization and Liability Waiver

Parents acknowledge that in case of illness or accident, Futurelink School has authority to secure necessary medical attention. Parents release any liability against Futurelink School, its faculty, and its drivers for medical aid rendered and will reimburse Futurelink School for medical and other expenses incurred in his/her case. Parents hereby waive all claims against Futurelink School, its faculty, and its drivers for illness, accident, injury, or death.

Media Release

Parent(s) grant permission for Futurelink School to use any photographs or video footage that may include images of his or her child for any Futurelink School promotional material or for any other purpose that Futurelink School deems appropriate including advertising, publicity, and web usage.

Accepted By: _____________________________

Date: _______________

22 W. Live Oak Ave. Arcadia, CA 91007 | Phone (626)446-3333 | Fax (626)446-0013 | Tax ID 95-4438507


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Futurelink Summer Tuition, Fees, and Schedule

Student’s Name _________________________________

Grade in Fall 2013 ___________

Schedule Week

1

6/17/13

2

6/24/13

3

7/01/13

4

7/08/13

5

7/15/13

6

7/22/13

7

7/29/13

8

8/05/13

9

8/12/13

10

8/19/13

✔ Lunch

7/04 off

Tuition Pricing 10 Weeks

$120/week

8-9 Weeks

$130/week

6-7 Weeks

$140/week

4-5 Weeks

$150/week

1-3 Weeks

$160/week

Half-Day

$85/week

Other Fees Registration Fee

$30

Full-Day Material Fee

$10/week

Half-Day Material Fee

$6/week

Lunch

$5/day

Amount Due (Office Use Only) ___________________ Tuition (First Child)

_________________ Registration Fee

___________________ Tuition (Second Child) 10% off

_________________ Material Fee

___________________ Tuition (Third Child) 10% off

_________________ Lunch

___________________ Total Amount (Please make checks payable to Futurelink).

Payment Method Cash Check

Check Number(s)

22 W. Live Oak Ave. Arcadia, CA 91007 | Phone (626)446-3333 | Fax (626)446-0013 | Tax ID 95-4438507


2013summerregistrationformpdf