Early Bird Re-Enrollment Form

EARLY BIRD RE-ENROLLMENT FORM
Attention Parents! If you would like to re-enroll during the Early Bird Re-Enrollment period, please fill out the information below by Friday, December 11, 2020
Student Information
Student Name*

First NameLast Name
Grade*
Parent / Guardian Information
Parent / Guardian Name*

First NameLast Name
Email Address*
example@example.com
Cell Phone Number
Registration Information
Please note that the registration fee is due upon completion of this form in order to receive the Early Bird price.

Annual Registration Fee: $400

$300 (If paid on or before December 11, 2020)
$400 (If paid after December 11, 2020)
Payment Information

Please enter the amounts that you’d like to apply to each category.

Total Fee$300.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I understand that all fees paid are non-refundable.
Signature*

Clear
Legacy Christian Academy

27680 Dickason Drive
Valencia, CA 91355
Phone: 661.257.7377
Should be Empty:

EARLY BIRD RE-ENROLLMENT FORM