Elementary Program Statement of Account


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ELEMENTARY 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: _______________________________________ TELEPHONE: (______)_______________

POSTAL CODE: __________________ LOCATION: ____________________

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 415 Toynevale Rd., Pickering or 56 Old Kingston Rd., Ajax.

* Specific Days:__________________________	* Times: ___________________	$__________________
5 DAY EXTRA SUPERVISION: Times a.m.	_______________ p.m.
Sub-Total		$__________________
10% SIBLING DISCOUNT:		$__________________
TOTAL FEES		$__________________

Please find enclosed post-dated cheques ( ) 1 Full Payment, ( ) 5 Installments, ( ) 10 Installments
(dates as indicated below) and the $100 Registration Fee.

1 Full Payment Dated by June 1.
1 Full Payment Dated by August 1.
5 Installments Dated June 1, August 1, October 1, December 1, and January 15.
10 Installments Dated August 1 to May 1.

OFFICE USE ONLY

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DO NOT WRITE BELOW THIS LINE

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OFFICE USE ONLY

REGISTRATION FEE: ______________

______

$ 100

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.