Cool Currents Registration – 2014 RE-ENROLLMENT FORM : 2015-2016 Please complete the below re-enrollment form and submit the deposit of $100/ child for each of your children you wish to enroll. The $100 deposit is payable towards your 2015-16 tuition. Student(s)Enter student information belowStudent #1* First Last Student #1 grade level for 2015-16 year:*----First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeStudent #2 First Last Student #2 grade level for the 2015-16 year:----First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeStudent #3 First Last Student #3 grade level for the 2015-16 year:----First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeStudent #4 First Last Student #4 grade level for the 2015-16 year:----First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradePrimary Parent ContactEnter the info for the primary parent contact belowParent Name* First Last Email* Phone*Re-Enrollment DepositThe $100 re-enrollment deposit is required for each student. (The deposit holds your child's enrollment spot and will be applied toward September 2015 tuition.)Select # of students* Price: $100.00 Quantity: Deposit Total $0.00 Payment Info*Enter your credit card info in the secure form below. American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I AGREE:* I will be re-enrolling my child(ren) in Northstar School for the 2015-2016 school year. Please hold a spot for my child(ren). I understand that I am submitting a NON-refundable $100 deposit for each child.