Individual Enrollment Form

Individual Enrollment Form

You must agree to the program polices before submitting this form. If you have not yet read them please do so here.

Agreement

I have read and agree to the Program & Payment Policies.

I have downloaded and intend to mail/fax/email the Required Documents (click to download PDF) to Carlisle Academy for the current school year.

 

Student/Contact Information

Student:

Date of birth:

Parent/Legal guardian:

Address:

City:

State:

Zip:

Phone:

Email:

 

Program & Tuition

Class Name:

Registration Deadline:

6 or 12-Week Session: SpringSummerFall

Tuition:

Per Diem Rate (if applicable):

Pro-rations/Discounts: NoYes

The tuition (or your portion of tuition) is due by the beginning of the session. If you are unable to pay your balance at this time, please contact the office to establish a payment plan.

 

Financial Aid

Scholarship pending with Carlisle Charitable Foundation? NoYes

Amount requested:

 

Private Insurance

Private Insurance Carrier:

Policy No.:

Subscriber:

Date of birth:

Relation to student:

 

Scheduling

Please indicate the day of the week and the time of day you would like to attend.
Wednesday - AMWednesday - PMThursday - AMThursday - PM

Specific time parameters:

Dates unable to attend: (tuition still applies unless excused absence)

Notes:

 

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