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SCHOOL YEAR FROM SEPTEMBER, 2006 TO JUNE,
2007
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CHILD'S SURNAME: __________________________ CHILD'S NAME:
______________________
ADDRESS: __________________________________ DATE OF BIRTH: (M/D/Y) _____________
CITY:
_______________________________________ TELEPHONE: (______)_______________
POSTAL CODE:
__________________
LOCATION: ____________________
COMMENCING DATE: ________________________ CLASS:
______________________________
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Please indicate session ( x ) and
amount, and place amount in "Total" Column
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Casa
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Elementary/Renaissance
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Total
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Times
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A.M._______
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P.M._______
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FULL_____
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5 Days*
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( ) $_______
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( ) $_______
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( ) $_______
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( ) $_______
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1st Child $_____________
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4 Days*
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( ) $_______
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( ) $_______
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( ) $_______
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( ) $_______
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2nd Child $_____________
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3 Days*
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( ) $_______
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( ) $_______
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( ) $_______
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( ) $_______
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3rd Child $_____________
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* Not available at 415
Toynevale Rd., Pickering
or 56 Old Kingston Rd., Ajax.
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* Specific Days:__________________________
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* Times: ___________________
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$__________________
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5 DAY EXTRA SUPERVISION: Times a.m.
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_______________ p.m.
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Sub-Total
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$__________________
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10% SIBLING DISCOUNT:
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$__________________
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TOTAL FEES
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$__________________
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Please find enclosed post-dated cheques ( ) 1 Full
Payment, ( ) 5 Installments, ( ) 10 Installments
(dates as indicated below) and the $100 Registration Fee.
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1 Full Payment Dated by June 1/01.
1 Full Payment Dated by August 1/01.
5 Installments Dated June 1/01, August 1/01, October 1/01, December 1/01,
and January 15/02.
10 Installments Dated August 1/01 to May 1/02.
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OFFICE USE ONLY
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------------
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DO NOT WRITE BELOW THIS LINE
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OFFICE USE ONLY
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REGISTRATION FEE: ______________
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______
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$ 100
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MARCH
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____ 20__ ______
$________________
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NOVEMBER
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____ 20__ ______
$_________________
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APRIL
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____ 20 ________
$________________
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DECEMBER
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____ 20__ ______
$________________
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MAY
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____ 20 ________
$________________
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JANUARY
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____ 20__ ______
$________________
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JUNE
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____ 20__ ______
$________________
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FEBRUARY
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____ 20 ________
$________________
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JULY
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____ 20__ ______
$________________
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MARCH
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____ 20__ ______
$________________
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AUGUST
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____ 20__ ______
$________________
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APRIL
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____ 20 ________ $________________
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SEPTEMBER
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____ 20__ ______
$________________
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MAY
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____ 20__ ______
$________________
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OCTOBER
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____ 20__ ______
$________________
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JUNE
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____ 20__ ______
$________________
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____ Acknowledgement
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_____ Package
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_____ Copy
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_____ Register
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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.
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