Back to Pearblossom Private School K - 8


K-8 ENROLLMENT APPLICATION (High School (Grades 9-12) Enrollment Application)
Pearblossom Private School K-8, P.O. Box 439, Bogue Chitto, MS 39629 Please provide copy of birth certificate and a small photo of student for our records.
These items can be scanned and emailed to us at [email protected] or mailed to our office. Remember to check the box under Additional Fees if the program is being sent outside the US; $120 will be charged for shipments outside the USA even if the box is left unchecked.
Parent's Full Name: Student's Full Name:
Address: Date of Birth:   Check if enrolling 2 or more students (Note: You will need to fill out a separate application for each student.)
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:

ABOUT SSL CERTIFICATES

Important Notice for students in CALIFORNIA ONLY: All students located in CALIFORNIA who are enrolling in any grade (elementary and middle school--grades 1 through 8) must complete the online Private School Affadavit form which is available at this link Calif. Dept. of Education Private School Affadavit Form. Failure to file this form could result in mandatory attendance at a local Public School.
Phone
Student has book Young People Ask? Yes   No
Alternate Phone:
Check if you have Internet Access  No Internet
Check if 2nd Semester Only--Not applicable for Combination 7/8th Grade

Place in the desired grade:  		 Elementary Grades
Textbook
 High School Grades
High School Enrollment Application
K
 1st
 2nd
 3rd
 4th
 5th
 6th3
 7/8th4
 High School Enrollment Application
Tuition1 $595 each elementary grade level $875 $1000
Book Fee2 $0 $200
Total Amount $595 each elementary grade level $1075 $1200
Down Pmt.5 $295 $475 $600
No. of Monthly Payments6 6 x $50 8 x $75
1Tuition does NOT include (a) the required Book Fee for Middle School (7/8th) and (b) an additional $120 fee for shipments outside the USA. The student may work at his or her own pace, generally taking 9 to 12 months to finish; however, an additional $50 fee is incurred for each additional month the student is enrolled beyond the 12th month. If 2nd Semester Only--must submit transcripts that confirm 1st Semester was completed and passed.
2If student re-enrolls and all text books have been returned and received by Pearblossom in good condition, then book fee will be waived.
3The 6th Grade "Textbook" program uses textbooks for each subject where tests are graded instantly online.
4Even though a combination grade has been selected, the program is to be completed in 9 to 12 months.
5The credit card used to make the initial down payment will be set up on monthly "autopay" until balance has been paid in full.
6Payments must reach us by the 15th of the month or a late fee of $20.00 will be incurred.
For 7/8th Grade: If student was previously enrolled in Pearblossom in the 6th grade textbook program please check:
Select Math Desired:   General Math   Pre-Algebra
Previous School:

Fax No.: 		Address:
City:
State & Zip:
Additional Fees:
REQUIRED Postage/Handling Fee of $120 for shipping to CANADA, MEXICO, and other addresses outside the 50 States of the USA.
     $75 Drawing Program
Total of Additional Fees: $   If paying by CHECK or Money Order, print this form and send with check - DO NOT PRESS SUBMIT. Note: Check or Money Order must be drawn on a USA bank--not a foreign or Canadian bank--even if funds are shown in USA Dollars. Credit Cards from other countries are acceptable.
15- or 16-digit Charge Card Number: 3 to 4-digit CCV, CVC, or CV2 Code:
ONLY for American Express cards: Download the required form, then scan and email the completed and signed form to [email protected] or fax to 601-835-1718 or mail to: Pearblossom Private School K-8. Box 439, Bogue Chitto, MS 39629
Check ONLY if you are making a down payment AND desire to make monthly payments using the specified card number. Card will be charged on the 8th of each month until balance is paid in full.
Name on Card:     Expiration Date (mm/yy):     Amount to Charge: $ (representing the initial payment).

Tuition Fee and Enrollment AGREEMENT: I acknowledge that there is NO guarantee that credits earned at PPS will be transferable or acceptable to other educational institutions. Receiving schools may require entrance exams as a part of their enrollment process. Also, a $50.00 per month additional fee is incurred for each additional month the student is enrolled beyond the 12th month. I, (type full name of parent/guardian) , the undersigned, hereby authorize Pearblossom Private School K-8 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 $15.00 service charge will be incurred on all returned checks. An $85 fee will be incurred for each replacement text book or DVD. A maximum limit of 12 months is allowed for the enrolled student to complete each grade. A complete refund, less $100.00 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 3-8 weeks for delivery. Pearblossom Private School K-8 (PPS) cumulative liability to undersigned 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 USA 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 the undersigned 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 the undersigned to check state attendance laws; PPS is not responsible for ensuring compliance with state or local truancy laws; that is the responsibility of the undersigned. Furthermore, the undersigned is responsible for the expense of returning and insuring the books and accomplishing any required state testing. Regardless of state testing requirements, PPS highly recommends the student take a nationally normed test at the parent or guardian's expense which can often be accomplished coincident with public school testing. Accreditation and associated requirements are subject to change without notice. Any student found by PPS to be cheating on tests will be disenrolled immediately with NO refund or credits issued. Any prior "Book Deposit" agreed to in prior year's agreement is now considered as a "Book Fee" as discussed above. This Agreement constitutes the entire agreement between the undersigned 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 (Type Your Full Name):
Date (mm/dd/yy):What is your age:
   
Pearblossom Private School Grades K - 8