The Encinitas Learning Center
2011 Summer Program Application Form
 6 week Program - ( July 9 - August 17 )
            

Summer Tuition Costs:*     Foundational Session:  $3600 (2 hours a day/6 Weeks)
Elective: $1980(1 hour a day per elective/6 weeks)   1 on 1              

                           *Early Enrollment Special:  Tuition $3500/Electives $1880            
Discount applies to all programs paid in full by the last day of May        

Please note:  Morning spots fill up quickly so please reserve your child's spot soon!
Payment is required to reserve your child's space.
                      (See payment options below)

Student's Name:

Student's Age:

Student's Grade:

Gender:

Female Male

Foundational Skills:
(2 hours daily)

Select which program you would like your child to use as part of
the Foundational Skills Program:
Cogmed® ?
Fast ForWord® ?
Interactive Metronome® ?
P.A.C.E.® ?
Pay Attention® ?
Samonas Sound Therapy® ?

Select your preferred timeslot:
8:00 am - 10:00 am 10:30 am - 12:30 pm 1:30 pm - 3:30 pm

Electives:
(1 hour daily)

Select one:
Math - Elementary Math/Science - Upper Grades Reading (Guided) Vocabulary & Writing

Special Needs/Requests:

Parent/Guardian's Name:*

Home Phone:*

Work Phone:

Cell Phone:

Email:*

Emergency Contact:

Please list an emergency contact other than you who we may contact in case of emergency.  Include person's full name and numbers where this person can be reached.  Thank you.

PLEASE READ

Consistent attendance is critical to a student's progress.  If a student must be absent, the session should be rescheduled within the same week if possible. 

There will be no tuition credit for missed times, but make-ups may be scheduled at your request if proper notice is given as follows:

Student Illness:            Minimum 1 hour notice
Non-Illness Absences:  Minimum 24 hours notice

Make-ups must be done within 30 calendar days of the absence; however, no make-up classes will be rescheduled if missed.  

We have found that this policies are necessary to provide consistency in learning and to maintain our excellent quality of service.  Thank you for your understanding and help.

I have read & understand the Attendance Policy*

Payment Options:

Your child's space in the summer program will be reserved upon payment only.

Payment by mail (Check or Visa/Mastercard):
Please print a copy of form, complete and sign it and mail to the Encinitas Learning Center at 543 Encinitas Blvd., Suite 100, Encinitas, CA  92024-3730.

Payment On-Line:
Please complete this form and click "submit" below.

Parent/Guardian Signature

Credit Card:

VISA Master Card

Name on Card:*

Card No.:*

Expiration Date:*

Security Code: *

3 Digit Security # is located on the back of your VISA or Mastercard

Billing Address:*

Please type in your street address, city, state and zip code.