Tustin Memorial Academy – Foreign Language Club Enrollment Form
Please complete one form per student per class enrolled
Return completed form with payment to your child’s teacher or in the school office
(Foreign Language Folder) by Sept. 16th. Classes start the week of September 30th
Classes Offered (All schedules tentative, classes are held on TMA campus, rooms
TBD)
Circle class as applicable:
Monday
8:50– 9:35 am
Tuesday
Wednesday
Thursday
Friday
LATE Kinder
Spanish
EARLY Kinder
Spanish
11:30–12:15
pm
1:20 – 2:20
Continuing Sp.
pm
(II)
2:35 – 3:35
Beginning Spanish Intermediate Sp.
Chinese
pm
(I)
(III)
2:50 – 3:50
Korean
French
Advanced Sp.
pm
(IV)
Chinese and French–TBD per enrollment 2:50 – 3:50 pm. Beginning Spanish is 2:45-3:45
Please refer to Foreign Language Flyer for class description to determine which class is right for
your child. Please take a moment to review our program policies (both documents available at
www.mytma.org, under After School Programs)
Child’s Name____________________________________________________Grade________Teacher
____________________
Address _______________________________________________________City____________________
Zip ________________
Parent or Guardian Name____________________________________ Email
_________________________________________
Phone: Home________________________________________________ Cell
__________________________________________
After program student will: _________ be picked up__________ go to CDC __________ walk
home
Kindergarten Students only (Please check one):
_______My child is an Early Bird Kinder and will be walked to class by the room parent
after Spanish.
_______My child is a Late Bird Kinder enrolled in CDC’s before school program; room
parent will bring to Spanish class _______I will pick up my child after Spanish class
______Room parent will walk my child back to CDC.
TUITION AMOUNT: $384
DISCOUNTS:
10% Sibling Discount (one per family)
5% Returning Student Discount (see note)
25% Room Parent Discount
Note: Returning Student discount applies only if child was enrolled in a class during the
2012-2013 school year.
Room Parent is responsible for making sure each student gets to class, and communicating &
distributing information to parents about the class on a first come, first served basis. Please
contact PTO coordinator below for additional information. If sibling discount applies, please enter
sibling info.
Name____________________________ Enrolled in____________________
Payment Options & Schedule:
_______I choose to pay tuition in full
_______I choose to pay tuition in three installments. Divide TUITION AMOUNT above by 3
and enter installment amount here: $__________ (First installment due with registration,
second installment due 12/1/13, third installment due 3/1/14)-Installment payments will
only be accepted by Credit Card
PAYMENT INFORMATION
_______I have enclosed payment by check made out to: CONVERSA for Spanish, Chinese &
French Classes (There will be a $25.00 fee for returned checks)
________Charge my VISA/MASTERCARD per payment schedule.
Name on Card________________________________________________
Exp. Date_________________ 3 digit sec.__________________ Today’s
date______________________________________
Card # _____________________________________________________Signature
______________________________________
Billing address & zip if different from
home_________________________________________________________________
If paying by credit card, your account will be charged automatically on the due date as
per the schedule above.
Questions? PTO Coordinators:
Grace McNamee: gmcnamee@aol.com;
Kate Kersten:
310-902-6594
katekersten@cox.net; 714-313-6163
Tustin Memorial Academy
Foreign Language Club
2011-2012 Policies (Keep for your reference)
• There are no refunds for classes attended.
• Tuition must be paid in full or first installment for child to
start
attending class.
• Classes are subject to a minimum enrollment of 6 students
• Parent participation encouraged. Please call your child’s
teacher if you have
questions. Contact information will be available on the first
day of class.
Parents are welcome to observe class anytime.
• Classes are limited and spaces are offered on a first-comefirst served basis. • Parents are to pick up students
immediately after class (Contact room parent
if you will be
late for any reason).
• Parents are responsible for informing the instructor and room
parent if child
will be absent from class.
• TMA’s PTO reserves the right to take a child out of the
program for disruptive behavior. In these rare circumstances the
parent will be refunded the reminder of the paid tuition for the
program. If your child is ever at risk of being removed from the
class due to disruptive behavior you will receive both a verbal
and a written notice well in advance.
• TMA’s discipline agreement applies to all after school
activities.