SeaScape Educational Center
Enrollment Form
Please print and mail along with your down payment to the address below:


First Name Last MI Gender: M/F
Address     
City           State Zip
Country     
Phone:  Area Code  

Has the student attended school before?  Y/N   
If yes what grades?
(Public) : K 1 2 3 4 5 6 7 8 9 10 11 12
(Private): K 1 2 3 4 5 6 7 8 9 10 11 12
Student's Birth Date (mm/dd/yy):

Current grade level:
SEASCAPE entering grade:
Is the student enrolling in a special needs program? If so, please mark the appropriate box.
Special Needs Program  Special Needs/Deaf Program
SEASCAPE beginning month:
Last School Attended:          
Last School Address:           

Father's Name
Address          
Email:             
Home Phone:   (Area Code):
Employer        
Business Phone (Area Code):
Mother's Name  
Address             
Email:                
Home Phone      (Area Code):
Employer          
Business Phone (Area Code):  

Brothers/Sisters: 1 2 3 4
Does the student have a health problem? (Y/N)
If yes, please specify:   
Who will be the teacher?
Highest level of education achieved:     

If my application for enrollment in Seascape Educational Center is accepted, I will comply with all requirements regarding reports, fees, and instruction. I understand that failure to do so will result in the cancellation of enrollment and loss of credits.

PARENT SIGNATURE_______________________________________________DATE______________

All textbooks, workbooks, and course outlines are supplied.

YEARLY FEES:

Grades Kindergarten   ($650.00 per year)
$250.00 downpayment at time of enrollment--8 monthly payments of $50.00 thereafter.
Grades 1-6:   ($755.00 per year)
$260.00 downpayment at time of enrollment--9 monthly payments of $55.00 thereafter.
Grades 7-8: ($800.00 per year)
$260.00 downpayment at time of enrollment--9 monthly payments of $60.00 thereafter.
Special needs/Deaf Program:   ($750.00 per year)
$350.00 downpayment at time of enrollment--8 monthly payments of $50.00 thereafter.

Check ONE of the following methods of payment:
(Please make checks payable to: SEASCAPE EDUCATIONAL SERVICES)

 I will pay by Money Order          I will pay by Check


MC  Visa  Discover #    Expiration Date:    Amount $

Name on Card :   Signature :   Date:


Mail to:  
SeaScape Educational Center f P.O. Box 1014 Thousand Oaks, CA USA 91358 
   ( Enrollment Forms Continued below)



  ENROLLMENT FORMS (cont.)