Westmark School Summer Registration Form

BEFORE COMPLETING THIS FORM,

PLEASE NOTE THE FOLLOWING:

* Registration on or before May 1st is strongly recommended.

* If your child has an IEP and is not currently enrolled at Westmark, please send a copy with your application.

* We welcome non-Westmark students. However, assessments may be needed and a charge may apply.

* Classes are subject to adequate enrollment. If a class has to be canceled due to lack of registrants, you will be contacted for a second choice or given a refund for that class.

* Westmark's tutorials tend to fill-up quickly. Early registration is recommended.

* All applications will be accepted on a first come/first serve basis.

* Funded students need to take a minimum of four (4) hours of classes.

Registration Form

Child's Name

Current Grade

Parent's Name

Mailing Address

City

State

Zip

Home Phone

Cell Phone

Email Address

Enter your Email Address (again) to receive a copy of the application you are submitting along with your answers.

Current School

Date of Birth

School in Fall 2008

Grade Level

Has student previously attended Westmark Summer Program?

Yes

Where did you hear about this Summer Program?

ATTN: STUDENTS NOT CURRENTLY ATTENDING WESTMARK

Does student have a current I.E.P.?

Yes

Does student attend

Special Education classes?

Yes

If "YES" to either of these questions,

please send a copy of student's IEP with application.

PLEASE CHECK BOX NEXT TO THE COURSE(S) YOUR STUDENT WOULD LIKE TO TAKE

Elementary Courses

DEVELOPING ESSENTIAL READING SKILLS - Tuition: $800, plus $100 for testing

Section #1 = 8:00 a.m. - 10:00 a.m.

Section #2 = 10:20 a.m. - 12:20 p.m.

DEVELOPING ESSENTIAL MATH SKILLS - Tuition: $800

10:20 a.m. - 12:20 p.m.

Middle School Courses

EXECUTIVE FUNCTIONING SKILLS - Tuition: $800

8:00 a.m. - 10:00 a.m.

KEYBOARDING - Tuition: $800

10:20 a.m. - 12:20 p.m.

Middle and High School Courses

DEVELOPING ESSENTIAL MATH SKILLS - Tuition: $800

8:00 a.m. - 10:00 a.m.

DIGITAL FILMMAKING - Tuition $800

8:00 a.m. - 10:00 a.m.

FUN WITH PHOTOGRAPHY AND PHOTOSHOP - Tuition: $800

10:20 a.m. - 12:20 a.m.

High School Courses

DEVELOPING ESSENTIAL WRITING SKILLS - Tuition $800

10:20 a.m. - 12:20 p.m.

IVY WEST SAT COLLEGE PREP PROGRAM - Tuition $750

July 7th - July 18th* 8:00 a.m. - 11:00 a.m. *Except July 7th & 19th will be 8:00 a.m. to 12:00 p.m.

Tutorials

One, two or three hour sessions available and offered to students of all ages.

Please contact Diane Seaman at dseaman@westmarkschool.org or 818.986.5045 (x312)

to discuss specific arrangements.

ONE-TO-ONE TUTORIALS - Tuition: $60/hr.

1 hour per day for four weeks: $1,200

2 hours per day for four weeks: $2,400

3 hours per day for four weeks: $3,600

TUITION TOTALS AND PAYMENT

Class/Tutorial #1

= $

Class/Tutorial #2

= $

Class/Tutorial #3

= $

TUITION TOTAL = $

By check: Please make check payable to WESTMARK SCHOOL, attn. Summer School

Send to:

Summer School

Westmark School

5461 Louise Avenue

Encino, California 91316

By Credit Card

I am interested in charging the summer tuition and would like the Business Office to contact me.

REGISTRATION PROCEDURES & POLICIES

ADEQUATE ENROLLMENT POLICY

Classes are subject to adequate enrollment. If a class has to be canceled due to lack of registrants, you will be contacted for a second choice or given a refund for that class.

REGISTRATION

Registration is completed when we receive this form, the required fees and your signature below. We will send written confirmation of our having received your registration and tuition payment.

REFUND POLICY

Tuition fees are refundable only if application for enrollment is denied. Since budgeting commitments are made prior to the opening of Summer School, the school does not refund tuition, except in the manner outlined. The tuition fee for all courses INCLUDES a $50 non-refundable administrative fee. A student will receive a full refund (less the $50 administrative fee) when withdrawing on or prior to June 13th. No refunds whatsoever are made for withdrawals after June 13th. There are no exceptions to this policy. Since all courses are subject to adequate enrollment, a full 100% refund will be made in all cases when a class is canceled.

I have read and agree to the above:

Yes

Parent/Guardian:

Date:

REGISTER EARLY TO ENSURE SPACE * ON OR BEFORE MAY 1ST PREFERRED