Re-Enrollment Form | Our Lady of Lourdes

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Name*

Phone*

Email*

Re-Enrollment Preference

All families, except those whose oldest/only is graduating, must complete this form whether your student(s) will or will not be returning to Lourdes for the 2021-2022 school year. Re-Enrollment ensures your student(s)’s place in the classroom for the coming year.

Will your family be returning to Our Lady of Lourdes School?*

Yes, we will be returning

No, we will not be returning

Students Returning

Please list the children in your family that will be returning to Our Lady of Lourdes School (List oldest child first).

Name*

Do you have any other children that will be RETURNING to Our Lady of Lourdes School?*

Name*

New Applicant (optional)

I also wish to register another child NOT PRESENTLY attending Our Lady of Lourdes School.

Please complete an application by visiting the admissions page on our-lady-of-lourdes-school.org. Please note, there will be a $50.00 application fee due at the time the application is presented.
• For Kindergarten Application, Student should be 5 yrs. of age by Sept. 1, 2022 • For 1st Grade Application, Student should be 6 yrs. of age by Sept. 1, 2022

Name*

Student's Birthday*

Grade applying for:*

Notes/Message

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Re-Enrollment Fee (1 Student)

Price:

Re-Enrollment Fee (2 Students)

Price:

Re-Enrollment Fee (3 Students)

Price:

Re-Enrollment Fee (4 Students)

Price:

Re-Enrollment Fee (5 Students)

Price:

Re-Enrollment Fee (5 Students)

Price:

Coupon

Billing Address*

Street Address City State ZIP Code

How would you like to make your payment?*

Bank Account/ACH

Debit/Credit Card

Total

Pay by Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Pay by ACH - Bank Check*

Account Number Account Type Routing Number Bank Name

Consent

I agree to the payment policy below.

I authorize the company named on this web form to debit the bank account or credit card indicated in this web form, for the noted amount on today's date. This payment is for the goods and services noted on the web payment form. I understand that returns, refunds and cancellations are not permitted, however exceptions may be made on a case-by-case basis. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted transaction date. I agree that payments for billing schedules with common bill dates may be consolidated into a single payment. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that the company named on this web form may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card or bank account, and that I will not dispute the payment with my Credit Card Company or Bank, so long as the transaction corresponds to the terms indicated in this web form.

Re-Enroll Now

Re-Enrollment Preference

Students Returning

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Our Lady of Lourdes Parish School

18437 Superior Street Northridge, CA 91325

(818) 349-0245

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