STUDENT INFORMATIONType of Vacation Thanksgiving 2017 ProgramEducational Package Choice Please select one packageClassroom PackagePrivate Tutoring PackagePrivate Application Essay PackageIf choosing the Classroom Package please select one class: Classroom Package class choice (select one)SATSSATTOEFLRoom Package Choice A minimum of 4 days is requiredSingle Room ($600/day)Double Room ($400/day)Arrival & Departure Dates Student Full Name *Student Cell Phone Number *Email Address *Gender *MaleFemaleDate of Birth (MM/DD/YY) *Country of Citizenship Current Grade *School Name & Address Do you have any allergies? If yes, please describe Are you taking any medication? If yes, please list all medications Local Emergency Contact Name *Local Emergency Contact Phone Number *Name of Health Insurance Company Health Insurance Policy Number Primary Doctor's Name Primary Doctor's Telephone Number Parents' Address Parents' Email Address How did you hear about us? Internet SearchFriendsConsultantOther PRIVATE TUTORINGEducation Package #1 Please list Subject(s) requested for private tutoring:Subject(s) Education Package #2 Please list one Subject requested for private tutoringSubject Education Package #3 Please list one Subject requested for private tutoringSubject If you are interested in other LPS programs, please indicate your interest: Other LPS programs I'm interested in Summer SATSummer SSATIntensive EnglishThanksgivingWinter VacationSpring Break SIGNATUREParent/Guardian Signature *Date Signed (mm/dd/yy) *Student's Signature *Date Signed (mm/dd/yy) *Electronic Signature Lexington Prep School requires that you certify your application by submitting an electronic signature. To certify your application, read the text below and type your name in the signature box.APPLICATION FEE A non-refundable $300 deposit and $100 application fee are required with this application. Upon the payment of balance the deposit will be credited to your account. The balance is due 30 days prior to starting date. LPS does not accept credit cards.TRANSPORTATION Car services referrals for transportation needs upon requestTUITION REFUND POLICY Tuition in this contract includes fees for Room & Board. 1) A complete refund, less the deposit, is only guaranteed if applicant cancels 30 days or more before the program start date. The course deposit is non-refundable. If Student cancels 29 days to 1 day before the course start date, 50% of course fee shall be refunded less the deposit. Tuition will not be refunded on or after the program start date. In the event of cancelling or rescheduling a private tutoring session, if the school is not notified more than 5 days prior to the original scheduled date, the cancelled or rescheduled class hours shall be all paid for in full by Student. 2) In the event of the attitude or behavior of Student is offensive and hinders the study of other students, LPS shall have the right to give one warning to said Student. If LPS warns Student a second time, LPS reserves the right to deny Student from taking the course on that day. If LPS warns Student a third time, LPS will deny Student from taking the whole course, in order to stop said unacceptable behavior. In such event, tuition for the course missed shall not be refunded at all. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
