Bilingual Kids registration

Lifetime Montessori After School Spanish Club

Wednesdays, January 11, 2023 to February 15, 2023, 3pm - 4:15pm
Student's Name*

First NameLast Name
Grade and Age*

GradeAge
School Name*
Homeroom*
Language Proficiency Level*
Has your child enrolled in our programs before?*
Please describe area where your child needs most support with language learning.*
Special Instructions? IEPs (Please be specific), Allergies, etc..*
Parent Name*

First NameLast Name
Parent Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent E-mail*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Additional person authorized to pick up my child*

NamePhone number
How did you hear about us?*
I hereby allow Bilingual Kids to use my child's picture, face, or likeness in advertising for the sole purpose of promoting the Bilingual Kids program. I understand this could mean print, online, or video images of in-program activities.
I hereby release Bilingual Kids from any and all liability arising out of my child's participation in this program. I assume all risks associated with this activity. In case of illness/injury, I authorize a representative of Bilingual Kids to obtain immediate medical treatment for my child. I will not hold Bilingual Kids responsible for any billing or payment related to emergency medical care.
Parent/Guardian Signature*

My Products*

Lifetime Montessori After School Spanish Club

Wednesdays, January 11 to February 15, 3pm - 4:15pm

$210.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Choose from one of the PayPal options to make your payment.
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