Casa Program Statement of Account


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CASA PROGRAM STATEMENT OF ACCOUNT

SCHOOL YEAR FROM SEPTEMBER 200_ TO JUNE 200_

CHILD'S SURNAME: ____________________________________ CHILD'S NAME: ____________________

ADDRESS: ___________________________________________ DATE OF BIRTH: (M/D/Y) ____________

CITY: _______________________ PHONE: (_______)_________________ / (______)________________

POSTAL CODE: __________________ CAMPUS: ___________________________________

COMMENCING DATE: ________________________ CLASS: ____________________________________

Please indicate session ( x ) and amount, and place amount in "Total" Column

	Casa			Elementary/Renaissance	Total
Times	A.M._______	P.M._______	FULL_____
5 Days	( ) $_______	( ) $_______	( ) $_______	( ) $_______	1st Child $_____________
4 Days*	( ) $_______	( ) $_______	( ) $_______	( ) $_______	2nd Child $_____________
3 Days,*	( ) $_______	( ) $_______	( ) $_______	( ) $_______	3rd Child $_____________

*Not available at Pickering or Village Campuses. **3 ams only available at Rougemount Campus Annex and Milner Campus.

All 3 day sessions must be Mon-Tues-Wed or Wed-Thurs-Fri.

* Specific Days:__________________________	*Times:________________
5 DAY EXTRA SUPERVISION: Times: a.m. ________________ p.m. _________________		$__________________
Sub-Total		$__________________
8% SIBLING DISCOUNT (2^nd & 3^rd Child):		$__________________
TOTAL FEES		$__________________

Please find enclosed post-dated cheques ( ) 1 Full Payment, ( ) 10 Installments (dates as indicated below) and the $200 Registration Fee (per family).
1 Full Payment Dated by August 1. 10 Installments Dated August 1 to May 1.
FOLLOWING IS FOR OFFICE USE ONLY		DO NOT WRITE BELOW THIS LINE

REGISTRATION FEE: ______________ ________ $_________

MARCH	____ 20_______ $_____________	NOVEMBER	____ 20______ $_____________
APRIL	____ 20_______ $_____________	DECEMBER	____ 20______ $_____________
MAY	____ 20_______ $_____________	JANUARY	____ 20______ $_____________
JUNE	____ 20_______ $_____________	FEBRUARY	____ 20______ $_____________
JULY	____ 20_______ $_____________	MARCH	____ 20______ $_____________
AUGUST	____ 20_______ $_____________	APRIL	____ 20______ $_____________
SEPTEMBER	____ 20_______ $_____________	MAY	____ 20______ $_____________
OCTOBER	____ 20_______ $______________	JUNE	____ 20______ $_____________

____ Acknowledgement

_____ Package

_____ Copy

_____ Register

Please Read Statement of Account Thoroughly.
THIS FORM MUST BE RETURNED TO THE SCHOOL
Fill in all Fields and Attach Statement of Account for Blaisdale Administration.