Elsass Waitlist

Elsass Academy Waitlist
Parent 1 Full Name *
Parent 2 Full Name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 1 Number *

Area Code Phone Number
Parent 2 Number

Area Code Phone Number
Parent 1 Email *
example@example.com
Parent 2 Email
example@example.com
First Child Information
Last Name *
First Name *
Sex *
Birth Date *

Month Day Year
Current Age *
Hopeful Enrollment Date

Month Day Year
Date
Special Information Concerning Child:
Second Child Information
Do you have a second child?

No Yes
Last Name
First Name
Sex
Birth Date

Month Day Year
Current Age
Hopeful Enrollment Date

Month Day Year
Date
Special Information Concerning Child:
Please read below and check:
- I understand that there will be a $100.00 Waitlist Fee and it is non-refundable and will apply to my first full month’s tuition.
- I understand that when I am contacted and decide that I do want the spot I will be asked to make a Credit Card payment for 1/2 of the first full months tuition minus the $100.00 I have already put down as my waitlist fee. Until this payment has been made my spot is not reserved.
Check if you read and understand the above statements. *

Yes I understand the above.
Signature

Clear
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Elsass Academy Waitlist