LBSY Student Information 23/24
Please complete 1 form per student
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Child's Name *
Congregation *
Grade *
DOB *
School *
Allergies? Concerns?
Address *
Mother's Name *
Mother's Cell *
Mother's email *
Father's Name *
Father's Cell *
Father's email *
Emergency Contacts (Include at least 2 and include phone number and relation to child) *
May your information be shared in LBSY Directory? *
Tuition Prices for next question
Select the tuition amount for the grade level of the child
(if unaffiliated, please contact Bev Weinberg, 502-802-3855 for tuition costs)
*
A deposit of $250 per child must be mailed after completion of this registration form. Deposits can be made by check or Mastercard/Visa. Deposits will be deducted from tuition balance. Deposits/Forms are due by June 30th. If forms/deposits are received by June 30th, you may DEDUCT $50 early bird bonus! If registration forms/deposits are not received by July 14th, and additional $50 will be added to your account. 

Deposit should be mailed to: 
Andi Callam 6003 Vincennes Trail, Greenville, IN 47124
*
There are 2 options for tuition payment. Tuition must be paid in FULL by August 16th by check or credit card or you can set up a monthly payment plan via credit card. If you do not pay in full or set up payment plan by August 16th, you will be charged an additional $50 LATE FEE. If paid in full by August 16th you receive a 3% discount (MUST PAY BY CHECK TO RECEIVE DISCOUNT)
NO EXCEPTIONS! All monthly payments will be processed during the first full week of each month September - April. 

Please select the method you will pay by: 
(please select 2 options)
*
Required
If credit card, please provide information including the name on the card, card number, expiration date, cvv, and zip code.
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