Bilingual Kids registration

High Tech Elementary Explorer Spanish Club

Tuesdays Mornings, 8am - 8:50am, Jan 17 to Feb 21, 2023 and/or Wednesday Afternoons 12:45pm - 1:45pm, Jan 18 to Feb 22, 2023
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.
Parent E-mail*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
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*

Tuesday Mornings - High Tech Elementary Explorer Spanish Club

Tuesdays Mornings, 8am - 8:50am, Jan 17 to Feb 21, 2023

$140.00 Quantity

Wednesday Afternoons - High Tech Elementary Explorer Spanish Club

Wednesday Afternoons 12:45pm - 1:45pm, Jan 18 to Feb 22, 2023

$140.00 Quantity

Both Programs - High Tech Elementary Explorer Spanish Club

Tuesdays Mornings, 8am - 8:50am, Jan 17 to Feb 21, 2023 and Wednesday Afternoons 12:45pm - 1:45pm, Jan 18 to Feb 22, 2023

$250.00 Quantity

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Total

$0.00

Pay with Credit Card