Wellspring Community Programs
42675 Road 44
Reedley,CA 93654
Tel 866 364 0804
Fax 559 638 2685
www.wellspringprograms.com

A P P L I C A T I O N

Required fields are indicated by an •

Program: (check box) •

The Woodlands, TX Program
Other local Wellspring Community Program


Name of applicant •
Date of birth (mm/dd/yyyy) •
Age •
Gender •
Male Female
Home phone •
Applicant's email
Name of school
Parent Information: At least one parent's contact information must be provided. •
Mother's name
Mother's phone
 Mother's cell phone
 Mother's email
Father's name
Father's phone
 Father's cell phone
 Father's email
Home address (street address) •
Town •
State •
Zip •
How did you hear about Wellspring Programs?

T U I T I O N
Tuition before health insurance reimbursement is $850.00 per month. Recommended enrollment of 6 months; minimum of 3 months.

Check here if you're interested in receiving information on financing plans for your Wellspring Community Program


 
R E F U N D A B L E  F E E S
Family Workshop (refunded in full if family attends at least 2 workshops)   $400
Three-month "After Care" Program (refunded in full if student completes successfully)   $100


D E P O S I T
The non-refundable deposit is required to reserve a place in a program (per student). Submitting this application indicates acceptance of this policy. The deposit will be applied to tuition.
   $350


Pay by: •
Visa       Mastercard       American Express
Card Number •
 Security Code •
 Expiration Date •
 Amount to be charge •
Name as it appears on card •
Address •
 
S U B M I T T I N G  A P P L I C A T I O N
Please hit the Submit Application button below. You will be contacted by the Wellspring Admissions Office within 24 hours to confirm receipt of the appliciation, and to provide you with the full enrollment package.
 
T O  P A Y  B Y  C H E C K
Do not hit the Submit Application button. Instead, please print the completed application and mail along with your check (made payable to Wellspring Communty Programs) to:
Wellspring Community Programs
42675 Road 44
Reedley, CA 93654