EASTSIDE ACADEMY

Registration
Mail to: Kris York 6113 Westmoreland Ln Pasco, WA 99301
Contact numbers: Kris York- 380.8607 / Michelle Tvedt- 460.9522
Complete the forms below and mail to the above address. Material fees are due at the time of Registration or
th
no later than July 15 . Please make checks payable to Kris York. Once the material fees are received your
students enrollment is guaranteed. Space is limited. The first months tuition is due by the first day of class.

Student Name: _________________________________________________________________

DOB: ________________

Age: _________________

Grade Level (entering): __________

Address: ______________________________________________________________________
City/Zip: __________________________________ Home Phone: _______________________
Student's Cell Phone: ____________Student Email: ___________________________________

Parent name(s): ________________________________________________________________

Mother's phone: __________________________

Father's phone: ______________________

Mother's Email: __________________________

Father's email: ______________________

Child resides primarily with: (circle one)

Mother

Father

Both

Allergies (food or other): ________________________________________________________

_____________________________________________________________________________
Special needs: _________________________________________________________________
_____________________________________________________________________________
Is there anything about your child that would help us teach them more effectively? _________
_____________________________________________________________________________
_____________________________________________________________________________
Your child's biggest strengths are: _________________________________________________
_____________________________________________________________________________
Your child's greatest weaknesses are: ______________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Classes:

Saxon
Algebra

Apologia
Biology

General &
Physical

Language
Arts

American
Government

World
Geography

Material Fee
Monthly Tuition

$25
$60

$95
$60

$85
$60

$55
$55

$30
$55

$30
$55

Material/Lab fees are due no later than July 15th. If you choose to un-enroll after July 15th
material fees MINUS $50 is fully refundable.
Septembers tuition is due on the first day of class, Tuesday, September 6, 2016.
Tuition is monthly. There is a 10% discount off of the total monthly tuition when enrolling more
than one student OR for enrolling one student in more than one class.
Class Name

Material Fee

Sept. Tuition

Saxon Algebra 1
Saxon Algebra 2
Apologia Biology
Apologia General Science
Apologia Physical Science
Language Arts
American Government
World Geography
Subtotals:
enrollment total less 10%
discount for multiple
enrollment:

FINAL TOTALS:

For Office Use Only

Date Pd
Allergies
Spec Nds
Enr Comp

Mat Fees
Chk #

Date Depd

Date Pd

Sept Tuition
Chk #

Notes
Date Depd

Parent Contract 2016-2017

Parent name(s): ________________________________________________________________
1. My total Material/Lab Fee(s) of $_________ is due no later than June 15th, 2016 for
returning families, July 15th, 2016 for new families. Once the Material Fee is paid, my
student(s) is/are enrolled in this class. I understand that space is limited and if I fail to
pay this fee by the due date, my student's enrollment is not guaranteed.
2. I understand that if I choose to un-enroll after July 15th, my material fees LESS $50 is
fully refundable.
3. Tuition, in the amount of $_________ is due on the first class of every month. A late
charge of $25 will be assessed for any payments received after the 15th of the month.
Payments can be made by check, cash or credit card (which would include a 5%
convenience fee).
4. Class sessions will be videoed solely for safety and training purposes. Videos will never
be used for any purpose without prior written consent of the student and parents.
5. I ( )agree ( )disagree to allow photos of my child to be used on our schools website or
Facebook page.

Parent signature(s): _____________________________________________________________

Student Contract 2016-2017

1. I will turn in my work on time to the best of my ability.
2. I will practice integrity by doing my own work.
3. I will do my part to respect others by having a positive attitude and using uplifting language.
4. If I am struggling with my work or with other students, I will not hesitate to speak privately
with my teacher to seek solutions.

Student signature: ______________________________________________________________