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Pearblossom Private School, Inc. ENROLLMENT APPLICATION
 *** Please provide copy of birth certificate,a small photo of enrolled student for our records, and transcript of High School credits earned ***
Parent's Name
Student's Name
Address
Date of Birth
City
State
Zip
Email Address:
Student Gender: Male Female
Student Ethnicity:
(Select ONLY ONE)		 White (Caucasian) African American Hispanic Filipino American Indian Asian/Pacific Island Other, specify:
Phone
Student has book Young People Ask? Yes No
Alternate Phone:
Check if you have Internet Access
 No Internet
Place in the desired grade:
Elementary Grades
Middle School
High School Grades
K
1st
2nd
3rd
4th
5th
6th3
6th3
7/8th
9th
10th
11th
12th
11/12th
Tuition1
$425 $425 $425 $425 $425 $425 $425 $725 $800 $725 $725 $725 $725 $800
Book Deposit2 $0 $0 $0 $0 $0 $0 $0 $200 $200 $200 $200 $200 $200 $200
Total Amount $425 $425 $425 $425 $425 $425 $425 $925 $1000 $925 $925 $925 $925 $1000
Down Pmt.
$225 $225 $225 $225 $225 $225 $225 $525 $600 $525 $525 $525 $525 $600
No. of Monthly Payments4 4 x $50 4 x $50 4 x $50 4 x $50 4 x $50 4 x $50 4 x $50 8 x $50 8 x $50 8 x $50 8 x $50 8 x $50 8 x $50 8 x $50
Teacher's Editions Answers in back of the workbooks Not Available.
1Tuition does NOT include the Book Deposit which is also required.
2If student re-enrolls, 100% of Book Deposit is rolled over to next grade upon completion of all scheduled payments and return of all text books in good condition; if student graduates or does not re-enroll, 50% of the Book Deposit is non-refundable and the remaining 50% is refunded upon completion of all scheduled payments and return of all text books in good condition.
3We offer two different types of 6th grade programs. The "Elementary 6th Grade" uses a Workbook; the "Middle School 6th Grade" is a textbook program where we grade the tests.
4Payments must reach us by the 15th of the month or a late fee of $20.00 will be incurred.
For 7/8th Grade:
Select Math Desired General Math Pre-Algebra
For High School:
Desired Math:   Desired Electives: 1. 2. 3.
Previous High School Address
City
State & Zip
Fax No.


Additional Fees:
Illustration Library (v3.0) $25 CD-ROM version of Illus. Lib. $35 Spiral-bound Book of Illus. Lib. $10 Scripture Recall game $10 Publisher Exact Record Keeper (PERK)
Supplemental CDs $50 for Elementary $50 for Grades 7-12 Math
Not Available		 $50 for Grades 7-12 Learning Resource
Foreign Language CDs $75 Spanish $75 French $75 Italian $75 German
Hands-on Art Electives $75 Draw Today $100 Paint Today $300 Parelli On-Line Kit
$400 Parelli Liberty Kit
 $300 Parelli Freestyle Kit
$550 Parelli Finesse Kit
Total of Additional Fees: $ If paying by CHECK or Money Order, print this form and send with check - DO NOT SUBMIT
15- or 16-digit Charge Card Number: Check ONLY IF you are making a down payment AND you desire an automatic charge of $50.00 to the above card number prior to the 15th of each month until balance is paid in full.
Name on Card: Expiration Date: Amount to Charge: $

Tuition Fee and Enrollment AGREEMENT: I, , have enclosed $ (theinitial tuition payment ortuition amount in full) plus additional fees (if any). The undersigned hereby authorizes Pearblossom Private School, Inc. to obtain a release of student information, including transcripts, from previously attended schools. Should payment remain delinquent in excess of ninety (90) days the student shall automatically be dis-enrolled and an additional $50 processing fee will be required to reinstate enrollment. A $10.00 service charge will be incurred on all returned checks. A $65 fee will be incurred for each replacement text book. A maximum limit of 12 months is allowed for the enrolled student to complete each grade. A complete refund, less $50.00 shipping/handling or processing fee, will be issued upon cancellation within thirty (30) days from date of receipt of books and upon return of all books and materials. Payments must reach our offices by the 15th of each month or a late fee of $20 will be incurred. Please allow 4-6 weeks for delivery. Pearblossom Private School, Inc. (PPS) cumulative liability to me or the student or any other party for any loss or damages resulting from any claims, demands, or actions arising out of or relating to this Agreement shall not exceed the enrollment tuition fees paid for the curriculum provided. In no event shall PPS be liable for any indirect, incidental, punitive, special, or consequential damages, including legal fees, lack of transferability of credits, loss of (a) data by means of computer software or U.S. mail, (b) profits or revenues, (c) employment or education opportunities, whether based in contract, tort or otherwise, even if PPS has been advised of the possibility of any such loss or damage. I understand that PPS shall have the right to legal action for nonpayment of tuition and fees, and I will be responsible for all costs of collection, including court expenses and reasonable attorneys' fees. Since the attendance laws vary from state to state, PPS urges me to check my state attendance laws so that I may be in compliance. PPS is not responsible for ensuring compliance with local truancy laws; that is the responsibility of parents or guardians. Furthermore, parents or guardians are responsible to accomplish any required state testing at their expense. Regardless of state testing requirements, PPS highly recommends the student take a nationally normed test at parents'/guardians' expense which can often be accomplished coincident with public school testing. Any student found by PPS to be cheating on tests will be disenrolled immediately with NO refund or credits issued. This Agreement constitutes the entire agreement between parents/guardians and PPS and supersedes any prior agreements, representations, proposals, or understandings, whether oral or written, with respect to the subject matter of this Agreement. I have read and understand this Agreement as evidenced by my name and date below.
            Signature:                   Date:
 

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Pearblossom Private School, Inc., Quality Educational Programs Grades K-12 Since 1988