St. Joseph College  McEntegart Hall, 222 Clinton Ave 

Clinton Hills, Brooklyn, NY  11205  347-787-0435

STEAM Summer Camp!

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Payment Plan Application (Please print out and type or print clearly and complete all information)

Email Application to Register@thelearnatory.org, or Fax to 347-787-0435.

Financially responsible person’s information

Name___________________________________________________  Email___________________________________________

Address___________________________________________________________________________________________________

Home Phone (_________) ________________________________ Work Phone (________) _________________________

 

Parent or Financially Responsible Person’s  Signature __________________________________________________

 

Student Information          Student’s Name ______________________________________________________________

Calculation of Agreement


The responsible person should compare the estimates placed on this application to the actual charges and credits on the invoice.

Requesting Plan For:

FALL CHARGES:         Registration ________ Tuition ________ Supply Fees ___________ Misc. Fees ___________

WINTER CHARGES:   Registration ________ Tuition ________ Supply Fees ___________ Misc. Fees ____________


SPRING I CHARGES:  Registration ________ Tuition ________ Supply Fees ___________ Misc. Fees ____________

SPRING II CHARGES: Registration ________ Tuition ________ Supply Fees ___________ Misc. Fees ____________

SUMMER CHARGES:  Registration ________ Tuition ________ Supply Fees ___________ Misc. Fees ____________


Please CHECK the nonrefundable application fee of $60 on the Online Payment Portal.


Retain a copy of this application for your records.   Any applications received without the $60 fee will not be processed.


This authorization remains in effect while the student is enrolled in The Learnatory.  

I understand that I may terminate this authorization at any time by paying the outstanding balance in full and notifying
The Learnatory in writing.

Parent or Financially Responsible Person’s  Signature _____________________________________Date ________________


Approved_________________    Denied__________________          Date_________________________________________


This form will be returned to the applicant.