EVRIKA LEARNING CENTER
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Registration - White Plains 2017-2018
Location
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Please select
Darien, CT
White Plains, NY
Trumbull, CT
West Hartford, CT
Danbury, CT
*
Registration Fee $20
Payment in full is required with the registration.
PLEASE NOTE: DISCOUNTS FOR SIBLINGS AND THIRD+ SUBJECTS WILL BE REFUNDED AFTER PAYMENTS ARE RECEIVED.
STUDENT INFORMATION
Please complete a separate form for each child
Student's Full Name (First and Last)
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Age
Birthday
*
MM
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DD
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YYYY
Grade in 2017-2018
Please select
Nursery
Pre-school
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
CLASSES REQUESTED
Please selected classes for this child only
Russian - Fall Session
Russian/Music 01 (ages 3-4) Saturday 11:00-11:45
Russian 02 (ages 4-5) Saturday 10:10-10:55
Russian 03 (ages 5-6) Saturday 9:20-10:05
Russian 04 (ages 6-7) Saturday 9:30-10:15
Russian 05 (ages 7-9) Saturday 9:30-10:15
Russian 06 (ages 8-10) Saturday 11:20-12:05
Russian 07 (ages 10-11) Saturday 12:10-12:55
Russian 09 (ages 12-13) Saturday 11:20-12:05
Not sure, need help
Russian - payment for full year
Russian/Music 01 (ages 3-4) Saturday 11:00-11:45
Russian 02 (ages 4-5) Saturday 10:10-10:55
Russian 03 (ages 5-6) Saturday 9:20-10:05
Russian 04 (ages 6-7) Saturday 9:30-10:15
Russian 05 (ages 7-9) Saturday 9:30-10:15
Russian 06 (ages 8-10) Saturday 11:20-12:05
Russian 07 (ages 10-11) Saturday 12:10-12:55
Russian 09 (ages 12-13) Saturday 11:20-12:05
Not sure, need help
Play and Learn - Fall session
Play&Learn 0 (ages 2-3) Wednesday* 4:15-6:15
Play&Learn 1 (ages 3-4) Tuesday* 4:00-6:00
Play&Learn 1 (ages 3-4) Saturday 11:00-12:30
Play&Learn 2 (ages 4-5) Thursday* 4:00-6:00
Play&Learn 0am (ages 2-3) Tuesday, Thursday* 9:30-11:30
Play and Learn - payment for full year
Play&Learn 0 (ages 2-3) Wednesday* 4:15-6:15
Play&Learn 1 (ages 3-4) Tuesday* 4:00-6:00
Play&Learn 1 (ages 3-4) Saturday 11:00-12:30
Play&Learn 2 (ages 4-5) Thursday* 4:00-6:00
Play&Learn 0am (ages 2-3) Tuesday, Thursday* 9:30-11:30
Music, Theater, Art - Fall Session
Music 02 (ages 4-5) Saturday TBA
Music, Theater, Art - payment for full year
Music 02 (ages 4-5) Saturday TBA
World Around Us - Fall Session
World Around Us 1 (ages 7-8) TBA TBA
World Around Us 2 (ages 8-10) Saturday 10:30-11:15
World Around Us 4 (ages 10+) Saturday 12:10-12:55
World Around Us - payment for full year
World Around Us 1 (ages 7-8) TBA TBA
World Around Us 2 (ages 8-10) Saturday 10:30-11:15
World Around Us 4 (ages 10+) Saturday 12:10-12:55
Math+Logic - Fall Session
Math+Logic 1 (grades 1-2) TBA TBA
Math+Logic 2 (grades 2-3) TBA TBA
Math+Logic 3 (grades 3-4) TBA TBA
Math 06 (grades 6-7) Saturday 10:30-11:15
Math+Logic - payment for full year
Math+Logic 1 (grades 1-2) TBA TBA
Math+Logic 2 (grades 2-3) TBA TBA
Math+Logic 3 (grades 3-4) TBA TBA
Math 06 (grades 6-7) Saturday 10:30-11:15
Math 06 (grades 6-7) Saturday 10:30-11:15
PARENT INFORMATION
Full Name (first parent or legal guardian)
*
Full Name (second parent or legal guardian)
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Home Phone
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Work Phone
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Cell Phone 1
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Cell Phone 2
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Email 1
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Email 2
Additional contact information in case of emergency (phone #, name, relation)
Whom can we thank for recommending us?
CHILD EVALUATION AND GOALS FOR ATTENDING OUR PROGRAMS
This information is required for new students registering for Russian, Math, Art. Optional for returning students and new students registering for Music and Theater classes.
MATH
What would you like for your child to achieve as a result of attending our math program? Please select all that applies.
Improve math skills and be at a regular school level
Deepen and enhance math skills and be above regular school level
Improve test results
What is the most difficult area of math for your child?
What is the easiest area of math for your child?
How would you evaluate your child's interest in math?
likes it, wants to learn more
doesn't like it
doesn't care
What is your child's math skills evaluation at regular school? (expected, below grade level, above grade level)
Any other comments?
RUSSIAN
Alphabet
doesn't know alphabet
knows some letters
knows all letters
Reading
doesn't read
reads by letters
reads by syllables
reads by whole words
Writing
doesn't write
write's in print letters
write's in script
Speaking
doesn't speak
speaks slow
speaks fast
mixes Russian and English words
At home we speak
Russian
English
both
What would you like for your child to achieve as a result of attending our Russian program?
Any other comments?
ART
likes to draw
neutral in his/her interest
has attended other art classes before
familiar with watercolors
Do you permit us to publish photos with your child during lessons/breaks/events in our printed and online informational materials?
Yes
No
IMPORTANT
Please read before submitting your registration.
By submitting this registration, you agree to our terms and policies:
Tuition for your first session in the school year is due with the registration. For all subsequent sessions within the same school year - it is due by/on the first day of classes. A late payment fee of $25 will be charged if balance is not paid within 14 days from the start of each session and no payment arrangements are made in advance.
A registration fee of $20 is due with the registration (unless it is waived during special registration period). It is non-refundable. New students only and returning students with a change in a teacher only can cancel after the first class. Registration fee is not returned and tuition is fully refunded only in this case. Only if ALL of the classes you are registering for are marked as TBA, registration fee does not have to be paid with this registration.
New students ONLY may cancel after the very first month in their very first semester for a pro-rated refund. No other cancellations in the middle of any session are allowed. In case of special circumstances, a Director's approval is required for any cancellation in a middle of the session. If the cancellation is approved, there will be $50 cancellation fee. If a new student begins classes in a middle of semester, tuition will be pro-rated. Acceptance of new students in a middle of a session is limited. Cancellation for students that paid for the full year with a discount is subject to the Director's approval, $75 cancellation fee and the refund for the remaining classes is subject to the reversal of the discount for the full year.
Tuition is pro-rated from the first day of attendance only in the first session of attendance. All other sessions must be paid in full.
There are no refunds for missed classes. Homework for missed class(s) is available online.
Classes cancelled due to inclement weather will be re-scheduled. No refunds for missing a re-scheduled class. If any classes are canceled for other reasons, tuition will be pro-rated and refund issued.
If additional theater classes will be scheduled for rehearsals, adjustments to tuition will be made accordingly. Additional show participation fees are added each session for students attending Music 01, 02, 03, 04 and Theater classes.
Tuition Discounts
- Students taking 3 or more classes receive 10% discount on the 3rd and subsequent classes (5% on Play and Learn classes).
- Second child per family receives 10% discount (5% for Play and Learn classes).
No discounts for group Piano classes.
When you, the parent (s) or legal guardian, are at our classes facility with your child and your child is not engaged in a lesson activity, you have full responsibility for your child's actions.
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