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REGISTRATION
Fr. Justin's Learning Center (201)944-1376
223 14th Street Fax (201)944-0993
Palisades Park, NJ 07650
Child's Name________________________________________________
Address_____________________________________________________
Home Phone_________________________________________________
Date of Birth________________Sex______________New Student_____________
Returning Student__________
Parents Father Mother
Name________________________________________________________________
Employer_____________________________________________________________
Address_______________________________________________________________
Work phone_________________Ext._________________Fax.___________________
Child's Doctor___________________________________________________________
Name Phone #
Address_________________________________________________________________
Name of person authorized to pick up child in case of emergency. (when parent cannot be reached)
Name 1._______________________2.__________________________
Relationship:_________________ __________________________
Phone # ______________________ __________________________
Part II- Registration
MEDICAL EMERGENCY - In the event that a medical emergency occurs I authorize the Director of Fr. Justin's Learning Center to seek emergency medical care for my child as deemed necessary.
TUITION - Payments are due on or before the first day of each month. A late fee of $10.00 is charged if payment is not received within the grace period ( Date posted each month ). There is a $20.00 fee for returned checks. Tuition is due regardless of illness, vacation and other absences.
REFUNDS - Refunds are not made for any reason.
WITHDRAWAL - One month's written notice is required if a parent wishes to withdraw a child from school. If the written withdrawal notice is received Before the first day of month, then the June tuition will be applied to the upcoming month. HOWEVER if notice is not received before the first day of the month, then the June is forfeited and kept by the school. Fees cannot be adjusted due to cancellation of classes for holidays, vacations, snow days, emergency closing, etc.
CUSTODIAL INFORMATION- If the non-custodial parent is not included among those persons authorized by the custodial parent to pick up the child, please attach a copy of the appropriate documents (Court Order).
REGISTRATION FEE - $75.00 - THIS FEE IS NOT REFUNDABLE.
TUITION SCHEDULE FOR -1999 - 2000
Circle Money Amount, Choice of Days and sessino Mon. Tues. Wed. Thrurs. Fri.
A.M. P.M. Full
HALF DAY PROGRAM FULL DAY PROGRAM
2 DAYS - $155.00 2 DAYS - $270.00
3 DAYS - $185.00 3 DAYS - $290.00
4 DAYS - $205.00 4 DAYS - $315.00
5 DAYS - $225.00 5 DAYS - $350.00
I agree to pay the Annual Tuition of _____________for my child.
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I have read the above regulation and agree to abide by them.
______________________________________________________
Parent Signature Date
Child'S Name____________________________________________
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