Lifetime Montessori After School Spanish Club
Wednesdays, January 11, 2023 to February 15, 2023, 3pm - 4:15pm
Student's Name
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Grade
Age
School Name
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Homeroom
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Has your child enrolled in our programs before?
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Please describe area where your child needs most support with language learning.
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Special Instructions? IEPs (Please be specific), Allergies, etc..
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Parent Name
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Parent E-mail
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Emergency Contact Name
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Additional person authorized to pick up my child
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How did you hear about us?
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Photo/Video Release
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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.
Parent/Guardian Consent
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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
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Lifetime Montessori After School Spanish Club
Wednesdays, January 11 to February 15, 3pm - 4:15pm
$
210.00
Quantity
1
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