Re-Enrollment for 2021-2022 (Mid Year New Student)

Re-Enrollment Contract 2021-2022 (Mid-Year Enroll)

This Contract is between White Rock Montessori Elementary School of the Good Samaritan, Inc. (hereinafter “School”) and the parent(s) or legal guardian(s) (referred to as “Parent”, which term includes the singular or plural, as applicable) of enter Student's Name below (hereinafter “Student”). All persons signing this Contract are jointly and severally liable for the tuition and fees set forth herein and on the attached Schedule of Fees and Tuition. Parent’s signature and/or initials on this Contract evidences Parent’s understanding and agreement to the terms of this Contract, as follows:
Student's Name*
First Last
2021-2022 Grade Level*
- Primary Half Day
- Primary Extended Day (Child stays in the classroom for morning work cycle and lunch. Moves to Extended Day room for a rest period and play-based afternoon.)
- Primary Full Day (Child stays in classroom all day for morning and afternoon work cycle.)
- 1st Grade (Lower Elementary)
- 2nd Grade (Lower Elementary)
- 3rd Grade (Lower Elementary)
- 4th Grade (Upper Elementary)
- 5th Grade (Upper Elementary)
- 6th Grade (Upper Elementary)
- 7th Grade (Middle School)
- 8th Grade (Middle School)
Before School Care (BSC)
- Before School Care (BSC) - 2 days per week
- Before School Care (BSC) - 3 days per week
- Before School Care (BSC) - 4 days per week
- Before School Care (BSC) - 5 days per week
- No Before School Care
After School Care (ASC)
- After School Care (ASC) - 2 days per week
- After School Care (ASC) - 3 days per week
- After School Care (ASC) - 4 days per week
- After School Care (ASC) - 5 days per week
- No After School Care
Do you need to re-enroll another current WRM student for 2021-2022 as well?*
- Yes
- No
Student's Name*
First Last
2021-2022 Grade Level*
- Primary Half Day
- Primary Extended Day (Child stays in the classroom for morning work cycle and lunch. Moves to Extended Day room for a rest period and play-based afternoon.)
- Primary Full Day (Child stays in classroom all day for morning and afternoon work cycle.)
- 1st Grade (Lower Elementary)
- 2nd Grade (Lower Elementary)
- 3rd Grade (Lower Elementary)
- 4th Grade (Upper Elementary)
- 5th Grade (Upper Elementary)
- 6th Grade (Upper Elementary)
- 7th Grade (Middle School)
- 8th Grade (Middle School)
Before School Care (BSC)*
- Before School Care (BSC) - 2 days per week
- Before School Care (BSC) - 3 days per week
- Before School Care (BSC) - 4 days per week
- Before School Care (BSC) - 5 days per week
- None of the above
After School Care (ASC)*
- After School Care (ASC) - 2 days per week
- After School Care (ASC) - 3 days per week
- After School Care (ASC) - 4 days per week
- After School Care (ASC) - 5 days per week
- None of the above
Enrollment Information
1) Enrollment: Student will be enrolled for the 2021-2022 academic year in the grade indicated above. Parent is aware that a final determination of classroom placement will be made by the School in accordance with the School’s standard admissions or retention practices and that curriculum changes/decisions and enrollment levels, as well as the means of teaching and learning methods and location of learning, are made in the School’s discretion. Parent acknowledges that Parent’s execution of this Contract is not contingent upon the School offering any particular program, curriculum, classroom, employee, means of teaching or learning method, location of learning, or enrollment level and that all such processes are determined in the School’s sole discretion. This Contract is valid only for the academic year stated and does not entitle Student to any future enrollment.
The School will offer remote learning options for the 2021-2022 academic year on a semester basis - if this is of interest, please fill out this Google Form.
2) Enrollment and Related Fees: Parent understands that to reserve a place for Student for the 2021-2022 academic year, Parent must submit this original executed Contract along with the applicable fees on the attached Schedule of Fees and Tuition. Parent further understands that these fees are not refundable or transferable under any circumstances.
Please initial here that you understand and agree to the items 1 and 2 listed above.*
Tuition Information
Click here to view/download the 2021-2022 Tuition and Fees Information Sheet.
3) Tuition: Tuition amounts for the various grades are set forth on the Schedule of Tuition and Fees, incorporated herein by reference. Parent has selected the payment plan below for tuition. If Parent selects the 11 month payment plan, Parent will receive Truth In Lending Act (“TILA”) disclosures from the School. If Parent does not receive TILA disclosures from the School, Parent agrees to notify the School so TILA disclosures can be provided.
Parent has selected the following payment plan for tuition:*
- Annual Plan (1 Payment)
- Semi Annual Plan (2 Payments)
- Monthly Plan (11 Payments)
- Faculty/Staff Payment Plans (ONLY for current WRM Faculty/Staff)
Faculty/Staff Available Payment Plans*
Please see Section F for more details about amounts and due dates for each Payment Plan.
- Divided evenly and taken out over my paychecks.
- Annual Plan (1 Payment)
- Semi-Annual Plan (2 Payments)
- Monthly Plan (11 Payments)
4) Tuition Obligation: Parent understands that, although tuition may be paid in installments, this Contract is not fractional. Parent understands that Student is being enrolled for the entire School Year covered by this Contract. Parent further understands that the overhead expenses of the School do not diminish with the departure of some students and agrees that it is impossible for the School to determine at the time of Parent’s execution of this Contract the damage and loss to the School that would occur due to the later cancellation/withdrawal of some of the students who have enrolled. Therefore, once this Contract has been submitted to the School with the fee set forth in the attached Schedule of Fees and Tuition, Parent becomes liable for the entire year's tuition and fees as liquidated damages (and not a penalty) even if the Student is withdrawn, absent, or is involuntarily separated from School UNLESS the Parent terminates this Contract in strict accordance with the Termination Procedures set forth in Paragraph 5 below. If Student is withdrawn, absent, or involuntarily separated, for any reason, including without limitation, change of residence, health, withdrawal, or expulsion, after the termination dates set forth in Paragraph 5, there will be no refund or reduction of fees or tuition, and any unpaid balance will become immediately due and payable.
In addition, when a student withdraws or is separated from the School, it is difficult, if not impossible, to find a suitable replacement. It is especially difficult to find suitable replacements after the termination dates in this Contract, as such replacements will have accepted positions at other institutions and will be otherwise bound to those obligations of those institutions. Parent therefore understands that even if a new student is accepted at the School after Student’s withdrawal or separation, that new student will not be occupying the same spot that was reserved for Student and, by executing this Contract, Parent is waiving any claim that tuition paid by or on behalf of that new student mitigates Parent’s financial obligations under this Contract or any damages that the School may experience.
Please initial here that you understand and agree to the items 3 and 4 listed above.*
Termination and Late Fees
5) Termination Procedures: Parent must inform the Director, in writing, of any withdrawal prior to April 1, 2021, in which case no tuition is due to the School. If Parent notifies the Director in writing of their Student’s withdrawal after April 1, 2021 and before school starts, the tuition due and payable to the school is one-half the applicable amount set forth on the Schedule of Fees and Tuition. If Parent notifies the Director in writing of their Student’s withdrawal after school starts, the tuition due and payable to the School is the sum of the pro-rated applicable tuition from the start of the school year through the last day of attendance plus 1/2 of the pro-rated tuition from the last day of attendance through the end of the school year. Per school policy, the School retains all fees for students withdrawn or dismissed under any circumstances. Time is of the essence as to all deadlines stated in this Enrollment Contract.
6) Late Fees: Parent understands and agrees that a late charge of $30.00 will be added for any delinquent payment (which is defined as a payment not received within 10 days after the due date). In the event of default (default being 30 days past due), Parent agrees to pay all costs of collection, including collection agency fees, attorneys’ fees and costs, court costs, and interest of 1.5% per month. Further, as to any account more than 90 days in arrears, the School reserves the right to accelerate the total unpaid balance of tuition and fees due under this Contract. After accounts are more than 90 days in arrears, the account will be referred to the School’s collection agent and/or counsel for satisfaction.
Please initial here that you understand and agree to the items 5 and 6 listed above.*
School Norms
7) School/Family Cooperation: A positive and constructive relationship between the School and Family Member (defined as Parent, Student, or other person associated with Student) is essential to the School’s educational purpose and responsibilities to its students. If any Family Member engages in behavior, communications, or interactions on or off campus, that is disruptive, intimidating, overly aggressive, or reflects a loss of confidence in or disagreement with the School’s policies, methods of instruction, or discipline, or otherwise interferes with the School’s safety procedures, responsibilities, or accomplishment of its educational purpose or program, the School reserves the right to place restrictions on the Family’s Member’s involvement or activity at School, on School property, and/or at School-related events or to dismiss the Family Member from the community. The School may also place restrictions on a Family Member’s involvement or activity at School, on School property, or at School-related events for other reasons that the School deems appropriate. The School also reserves the right to withdraw an offer of enrollment or re-enrollment or to void an executed enrollment contract because of a Family Member’s violation of the expectations set forth in this Paragraph. Any determination under this Paragraph shall be in the School’s sole and reasonable discretion. There will be no refund of tuition where such dismissal occurs, and any unpaid balance is payable in full according to the terms of this Contract.Additionally, the School requires that all parents (married, unmarried, divorced, or separated) cooperate with one another in the best interests of Student’s education at the School. Failure of parents to cooperate with one another may lead to dismissal of Student or the School’s decision not to offer or to withdraw an offer of enrollment already made in future academic years. There will be no refund of tuition where such dismissal occurs, and any unpaid balance is payable in full according to the terms of this Contract.
8) School Rules: Student’s enrollment at the School is subject to the statements, rules, regulations, conditions, traditions, and financial terms contained in the School’s Student Handbook and other published documents, which are incorporated into this Contract by reference and may be amended from time to time. Parent acknowledges that Parent and Student must abide by such School rules and guidelines. Additionally, the School requires that all parents (married, unmarried, divorced, or separated) cooperate with one another in the best interests of Student’s education at the School. Failure of parents to cooperate with one another may lead to dismissal of Student or the School’s decision not to offer or to withdraw an offer of enrollment already made in future academic years. There will be no refund of tuition where such dismissal occurs, and any unpaid balance is payable in full according to the terms of this Contract.
Please initial here that you understand and agree to the items 7 and 8 listed above.*
Policies and Procedures
9) Termination of Student’s Attendance: The School has the right to suspend or terminate the attendance of Student for reasons set forth in this Contract, for reasons set forth in the Student Handbook (or other published document), for reasons that the School administration considers detrimental to the School community, to the Student, or to other students of the School, or for the Parent’s failure to pay all or any part of the Parent’s financial obligations for Student’s attendance (including any amounts charged on Student’s account with the School). There will be no refund of tuition where such dismissal occurs, and any unpaid balance is payable in full according to the terms of this Contract.
10) Medical Authorization: If, in the opinion of a properly licensed and practicing physician, Student needs medical or surgical services which require Parent’s pre-authorization or consent, Parent hereby authorizes, appoints, and empowers the School to act as Parent and furnish such consent on Parent’s behalf. Parent confirms that it is Parent’s desire that Student be furnished with such medical or surgical services as soon as reasonably possible after the need arises. Parent hereby releases and holds the School harmless from any liability which might arise from the giving of such consent. Parent agrees to reimburse the School for any medical expenditures made on Student’s behalf.
11) Consent to On Site Medical Care, Including Student Counseling: The Parent hereby authorizes the School to supply medical care as needed for Student (including administration of allergy medications, Epi-Pens, etc. according to the Student’s prescription from a licensed practitioner) or other minor medical care as determined to be appropriate by the School nurse. The Parent also authorizes the School’s student guidance counselor to meet and counsel with Student regarding emotional, social, or family circumstances. The School may require evaluation and/or therapy along with a reciprocal release so that the School can openly communicate with the therapist as a condition of continued enrollment if the School deems an evaluation or therapy to be necessary. Parent hereby releases and holds the School harmless from any liability which might arise from the provision of such medical care or counseling services.
12) Transcripts/Records: All accounts must be paid in full for all students Parent has enrolled in the School before records and transcripts can be released or transferred to other schools and colleges. Student will not be allowed to continue to attend classes unless tuition and fees are paid by stated deadlines (or until Parent makes other written arrangements acceptable to the School).
Please initial here that you understand and agree to the items 9, 10, 11, and 12 listed above.*
Permissions, Waivers, Releases
13) Photos, Voice, Images and Creations: Parent agrees to allow Student’s name, photograph, voice, image, and information to be used by the School, and those acting with the School’s permission, for use in the School’s publications, promotional materials, website, and social media accounts, without compensation and without prior notice. Parent agrees to allow Student to be interviewed by the media on campus or at School-related events. If the Parent wishes to revoke this permission, written notification must be submitted to the Director or designate so that it is received no later than June 1, 2021.
Parent also consents to the recording and distribution or live streaming of Student’s voice, image and video in instruction or presentations as may be deemed appropriate in the School’s discretion. If Parent does not want their student’s voices and images recorded during distance learning, the School is relying on Parent to take steps with their computer or the spacing of the child to the computer to block their child’s image from being recorded. If Parent does not want their student’s voice to be recorded, the School would similarly ask that Parent instruct their child not to verbally participate and advise the teacher of such instruction.
There may be times when teachers are having one to one video conferencing or digital communications with students and the school is relying on parents to monitor these from their end as they are in the best position to do so. Parent must inform the School of any concerns about any interaction.
Parent releases and holds the School harmless from any liability stemming from the use of the Student’s name, photograph, voice, video, image, or information.
14) School Directory: Parent authorizes the School to place family information, including name(s), home address(es), email address(es), and telephone numbers of Parent, Student, and other children in attendance at the School, in a directory of students to be distributed to School families. Parent acknowledges that this directory is not to be used for commercial use and is not to be distributed to any person or entity other than another School family. If Parent requests that their and their student's home address be omitted because of sensitive circumstances such as those listed in Texas Tax Code Section 25.025 and Parent provides the information that would substantially comply with subsection (d) of that statute, the home address and telephone number may be omitted from the directory.
15) Promotional Materials/Statements: The School continually strives to ensure the accuracy of all written materials, including, but not limited to, promotional information, catalogs, brochures, handbooks, and advertising. In an effort to do so, however, information included in the materials (including class sizes, student-to-teacher ratios, School accreditation, teacher qualification, specialization, and length of service, etc.) may change as programs grow and as staff changes. Prior to relying on any written materials in making your decision to enroll Student in the School, please verify the accuracy of information with the School. Please also understand that even if the information was accurate at the time that you enrolled Student, the information may change prior to commencement of classes or during attendance at the School. Please also note that only the Head of the School (or his/her designee) has the authority to make commitments regarding the nature of the program, specific arrangements for Student, or other changes from the School’s regular curriculum.
Please initial here that you understand and agree to the items 13, 14, and 15 listed above.*
Legal Issues
16) Domestic Legal Issues: Parent understands and agrees that the School’s primary purpose is to provide educational opportunities to the students within its institution. Parent also understands that it is disruptive to the School for a parent to involve the School (or any of its employees) in domestic legal disputes between the parents and that the School often must pay for legal fees and costs associated with such issues.
16a) Parent is obligated to promptly advise the School whether a parent/guardian is restricted in receiving information about Student from the School, in visiting/picking-up/dropping off Student, in participating in parent/student conferences, etc. Parent must also provide a valid court order to the School evidencing such restrictions. Parent is also under an ongoing obligation to provide any updated orders to the School.
16b) Parent agrees to promptly reimburse the School for all expenditures incurred by the School because of parent’s domestic legal disputes, including, but not limited to: parental disagreements about Student’s education or placement; divorce proceedings; custody proceedings; and/or modifications of custody proceedings. Costs incurred may involve reasonable attorneys’ fees/costs to prepare for and/or attend depositions, trials, or hearings; to communicate with Parent or Parent’s counsel, guardians ad litem or attorneys ad litem; to respond to subpoenas; to draft letters or motions; and to perform research. Costs include the cost of copying documents, providing records, engaging substitute teachers or temporary employees, computerized research, and travel expense. Parent agrees to reimburse the School for such fees/costs within thirty (30) days of the School billing Parent for such expenses. Any dispute between the parents regarding which parent may owe which portion of the bill should be resolved between the parents so that the bills for reimbursement to the School can be paid on a timely basis. Parent’s failure to pay such fees/costs promptly will result in dismissal of the family from the School.
17) Force Majeure: Should events beyond the control of the School, including, but not limited to, any fire, act of God, hurricane, tornado, flood, extreme inclement weather, explosion, war or armed conflict, governmental action, act of terrorism, risk of infectious disease, epidemic, pandemic, shortage or disruption of necessary utilities, or any other event beyond the School’s control, occur, the School has the discretion to close the School and/or modify its curriculum, schedules, length of school day, length of school year, and/or means of learning and teaching methods, including, without limitation, converting to distance learning or a hybrid model. Parent may be required to sign a waiver of liability in order for Student to participate in on-campus instruction depending on the status of any force majeure event. Parent’s financial obligations under this Contract remain in full force and effect and the School shall not be liable for any such failure or delay in its performance. Should the School close, the School’s duties and obligations under this Contract shall be suspended immediately without notice until the School, in its sole and reasonable discretion, may safely reopen. If the School cannot reopen due to a force majeure event under this Paragraph, the School is under no obligation to refund any portion of tuition paid.
18) Vaccinations: The School may require certain vaccinations, including vaccination for COVID-19, in addition to other mandated vaccinations, subject to the particular vaccine being specifically approved by a public health authority for administration to children under the age of 14, as a condition of on-campus instruction. The School will follow any legally required exceptions to its vaccination requirements.
19) Authority: Each party represents and warrants to the other (1) that it has full power to enter into and perform its obligations under this Contract; and (2) that this Contract constitutes its legal, valid, and binding obligation, enforceable in accordance with its terms. Parents in two-parent households agree that each is acting as agent for the other. Modification of this agency relationship shall be in writing and delivered to the School. No oral modifications will be recognized or accepted.
20) Assignment: This Contract shall inure to the benefit of and be enforceable by any successors or assigns of the School, including any entity with which, or into which, the School may be merged, or which may succeed to the School’s assets or business. This Contract is a personal contract, and the rights and interests of the Parent and Student may not be assigned or transferred by any of them.
21) Governing Law/Waiver of Jury Trial: This Contract shall be governed under the laws of the State of Texas. The venue of any action hereunder shall lie exclusively within the state and federal courts of Texas and the parties consent to personal jurisdiction and expressly waive all rights to trial by jury.
Please initial here that you understand and agree to the items 16, 17, 18, 19, 20, and 21 listed above.*
Terms and Conditions
22) Understanding of Terms: Please read this Contract carefully. By signing below, Parent acknowledges that Parent understands the terms of this Contract, Parent’s obligation to pay the full year’s tuition even if the Student is withdrawn or dismissed, Parent’s option to terminate and all other obligations set forth herein. If Parent has questions about the terms, Parent is encouraged to seek advice of counsel or to seek clarification from the School.
23) Entire Agreement: This Contract and the separately incorporated Schedule of Tuition and Fees sets forth the entire understanding of the parties hereto with respect to the subject matter hereof and merges and supersedes all prior and contemporaneous oral understandings between the parties. There have been no representations or warranties made by any party other than the representations and warranties contained herein.
24) Required Signatures and Representations: Both parents/guardians must sign this Contract, unless the School, in its discretion, permits enrollment with one parent/guardian signature. If only one parent/guardian signs this Enrollment Contract, such parent/guardian must have the authority to enter into this Contract on behalf of the Student and the consent of all other parents/guardians to do so. The submission of the Enrollment Contract with the signature of a single parent/guardian constitutes the representation of the signing parent/guardian that he/she has the necessary authority and consent to sign on behalf of the other parents/guardians. A parent/guardian who signs on behalf of other parents/guardians confirms he/she has authority and consent. Signing without authority and consent constitutes fraud. The parties agree and understand that a photocopy or an electronically signed contract is an acceptable substitute for the original and holds the same force and effect as a wet ink signature.
Please initial here that you understand and agree to the items 22, 23, and 24 listed above.*
Fees

Description	Amount	Due Date
Enrollment Fee - New Students	$635.00	With Enrollment Contract
Enrollment Fee - Returning Students	$495.00	With Enrollment Contract
Before/After School Care Registration Fee	$80.00	With Enrollment Contract
Supply and Field Trip Fee	$135.00	With First Tuition Payment
Middle School Resource Fee	$135.00	With First Tuition Payment
Upper Elementary Resource Fee	$80.00	With First Tuition Payment

Tuition

Annual Payment	Due June 1, 2021
Middle School	$15,676.00
Upper Elementary	$13,687.00
Lower Elementary	$13,687.00
Primary Full Day	$12,998.00
Primary Extended Day	$12,998.00
Primary Half Day	$8,141.00

Before School Care - 2 days per week	$696.00
Before School Care - 3 days per week	$1,044.00
Before School Care - 4 days per week	$1,391.00
Before School Care - 5 days per week	$1,729.00

After School Care - 2 days per week	$2,142.00
After School Care - 3 days per week	$3,213.00
After School Care - 4 days per week	$4,284.00
After School Care - 5 days per week	$5,324.00

Before & After School Care - 2 days per week	$2,597.00
Before & After School Care - 3 days per week	$3,896.00
Before & After School Care - 4 days per week	$5.195.00
Before & After School Care - 5 days per week	$6,455.00

Semi-Annual Payments	Due June 1, 2021	Due Dec 1, 2021	Total
Middle School	$8,151.52	$8,151.52	$16,303.04
Upper Elementary	$7,117.24	$7,117.24	$14,234.48
Lower Elementary	$7,117.24	$7,117.24	$14,234.48
Primary Full Day	$6,758.96	$6,758.96	$13,517.92
Primary Extended Day	$6,758.96	$6,758.96	$13,517.92
Primary Half Day	$4,233.32	$4,233.32	$8,466.64

Before School Care - 2 days per week	$361.92	$361.92	$723.84
Before School Care - 3 days per week	$542.88	$542.88	$1,085.76
Before School Care - 4 days per week	$723.32	$723.32	$1,446.64
Before School Care - 5 days per week	$899.08	$899.08	$1,798.16

After School Care - 2 days per week	$1,113.84	$1,113.84	$2,227.68
After School Care - 3 days per week	$1,670.76	$1,670.76	$3,341.52
After School Care - 4 days per week	$2,227.68	$2,227.68	$4,455.36
After School Care - 5 days per week	$2,768.48	$2,768.48	$5,536.96

Before & After School Care - 2 days per week	$1,350.44	$1,350.44	$2,700.88
Before & After School Care - 3 days per week	$2,025.92	$2,025.92	$4,051.84
Before & After School Care - 4 days per week	$2,701.40	$2,701.40	$5,402.80
Before & After School Care - 5 days per week	$3,356.60	$3,356.60	$6,713.20

Monthly Payments	June 2021 – April 2022	Total
Middle School	$1,524.85 per month	$16,773.35
Upper Elementary	$1,331.37 each payment	$14,645.07
Lower Elementary	$1,331.37 each payment	$14,645.07
Primary Full Day	$1,264.35 per month	$13,907.86
Primary Extended Day	$1,264.35 per month	$13,907.86
Primary Half Day	$791.90 per month	$8,710.90

Before School Care - 2 days per week	$67.70 each payment	$744.70
Before School Care - 3 days per week	$101.55 each payment	$1,117.05
Before School Care - 4 days per week	$135.31 each payment	$1,488.41
Before School Care - 5 days per week	$168.18 each payment	$1,849.98

After School Care - 2 days per week	$208.36 each payment	$2,291.96
After School Care - 3 days per week	$312.54 each payment	$3,437.94
After School Care - 4 days per week	$416.72 each payment	$4,583.92
After School Care - 5 days per week	$517.88 each payment	$5,696.68

Before & After School Care - 2 days per week	$252.62 each payment	$2,778.82
Before & After School Care - 3 days per week	$378.97 each payment	$4,168.67
Before & After School Care - 4 days per week	$505.33 each payment	$5,558.63
Before & After School Care - 5 days per week	$627.90 each payment	$6,906.90

Tuition Payment Method
How would you like to make your tuition payment(s)?*
The first tuition due date for the 2021-2022 school year is June 1, 2021.
- Debit/Credit Card
- Checking Account
- Savings Account
- Same payment method account as 2020-2021 tuition autopay
- Do not enroll in autopay and will make manual payments. Manual payments can be made through MyProcare.com with a debit/credit card (incurs 2.65% processing fee) or by delivering a check or money order to the school office. There is a $30 fee for payments received after the due date.
I have read and agree to these terms for tuition autopay.*
To properly affect the cancellation of these charges, I am required to give 10 days written notice.
- I hereby authorize White Rock Montessori to initiate credit card charges to the below-referenced credit card account on tuition plan due date(s).
*
- I acknowledge and agree to pay the 2.65% processing fee associated with credit card charges.
I hereby authorize White Rock Montessori to initiate debit entries to the below-referenced checking or savings account on tuition plan due date(s).*
To properly affect the cancellation of these charges, I am required to give 10 days written notice.
- I have read and agree to these terms for tuition autopay.
Account Holder Name*
For the account to be used for tuition autopay
First Last
Account Holder Phone Number*
For the account to be used for tuition autopay. If different from your phone number.
Account Holder Address*
Debit/Credit card to be used for tuition autopay.
Street Address Address Line 2 City State ZIP Code
Debit/Credit Card Number*
Debit/Credit card to be used for tuition autopay
Debit/Credit Card Expiration Date*
For the account to be used for tuition autopay
Bank or Credit Union Name*
For the account to be used for tuition autopay
Routing Number*
For the account to be used for tuition autopay
Account Number*
For the account to be used for tuition autopay
Enrollment and Other Applicable Fees
Your child's spot for the 2021-2022 school year is not reserved until these fees have been paid.
Enrollment Fee for Returning Students*
Price:
Staff Discount on Enrollment Fee for Returning Students
Price:
Enrollment Fee for Returning Students
Price:
Staff Discount on Enrollment Fee for Returning Students
Price:
Before and/or After School Care (B/ASC) Registration Fee
Price:
Staff Discount on Before and/or After School Care (B/ASC) Registration Fee
Price:
Before and/or After School Care (B/ASC) Registration Fee
Price:
Staff Discount on Before and/or After School Care (B/ASC) Registration Fee
Price:
Total Due to Finalize Enrollment
This total includes the Enrollment Fee and Before & After School Registration Fee (if applicable).
How would you like to pay the Total Due to Finalize Enrollment?*
- Same payment method as 2020-2021 tuition autopay.
- Same payment method as entered above on this form.
- A different debit or credit card.
- A different checking or savings account.
On what date would you like to pay the Total Due to Finalize Enrollment?*
- Immediately
- May 1, 2021
- June 1, 2021
- Divide this amount evenly over the 2021-2022 tuition payments
Debit/Credit Card Number*
Debit/Credit card to be used for tuition autopay
Debit/Credit Card Expiration Date*
For the account to be used for tuition autopay
Total Due to Finalize Enrollment - Credit Card Payment*
To be charged the Total Due to Finalize Enrollment upon submitting this form.
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Card Type (American Express, Discover, MasterCard, Visa)
Account Holder Name*
First Last
Account Holder Phone Number
Account Holder Billing Address*
Account to be charged the Total Due to Finalize Enrollment upon submitting this form.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Routing Number*
Account to be debited the Total Due to Finalize Enrollment upon clicking "CONTINUE".
Account Number*
Account to be debited the Total Due to Finalize Enrollment upon clicking "CONTINUE".
Bank or Credit Union Name*
Signatures
Signature of Parent or Legal Guardian*
Please type your first and last name to serve as your electronic signature.
First Last
Signature of Parent or Legal Guardian
Please type your first and last name to serve as your electronic signature.
First Last
The person signing below, although not a Parent or Legal Guardian, is agreeing to be responsible for all financial obligations set forth above:
(if applicable)
First Last
Person above's relationship to student
Confirmation Email
Your Email Address*
Where you would like to receive your email confirmation.
Additional Email Address (Optional)
Where you would like a copy of your email confirmation sent.
White Rock Montessori does not discriminate on the basis of race, color, religion, sex, nationality or ethnic origin in its admissions, availability of programs or administration of policies and services.

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Re-Enrollment Contract 2021-2022 (Mid-Year Enroll)

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