Franklin Spanish Club
Tuesdays, Nov. 29, 2022 - January 31, 2023 - 2:50pm - 3:50pm
Student's Name
*
First Name
Last Name
Grade and Age
*
Grade
Age
School Name
*
Homeroom
*
Language Proficiency Level
*
Please Select
Beginner
Intermediate
Advanced
Has your child enrolled in our programs before?
*
Please Select
YES
NO
Please describe area where your child needs most support with language learning.
*
Special Instructions? IEPs (Please be specific), Allergies, etc..
*
Parent Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Parent E-mail
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Additional person authorized to pick up my child
*
Name
Phone number
How did you hear about us?
*
Photo/Video Release
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
*
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
*
Clear
My Products
*
prev
next
( X )
Franklin Spanish Club
Tuesdays, Nov. 29, 2022 - January 31, 2023 - 2:15pm - 3:15pm
$
95.00
Quantity
1
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Register Class
Should be Empty: