Language
English (US)
Français
PhilaFLAM - Registration
Please fill out this registration form. Information will remain strictly confidential and will only be used to determine which class your child may attend. We will confirm the registration as soon as possible.
I have read and accept the Privacy Policy
*
Preferred school
*
Please Select
Bryn Mawr
Princeton
IB Harriton High School
Hoboken
1st Parent or Guardian
Name
*
First Name
Last Name
Email
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What language does the 1st parent use with the child?
*
Please Select
French
English
Other
2nd Parent or Guardian
Name
First Name
Last Name
Email
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
What language does the 2nd parent use with the child?
Please Select
French
English
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about PhilaFLAM?
We receive subsidies based on the number of children of French nationality. Please let us know if you or your child(ren) are French.
Yes
No
Back
Next
Your child/teen
Every child/teen must understand French very well to be comfortable in their class. Email contact@philaflam.com if it's not the case!
Student name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
How would you rate your child/teen abilities in French?
*
Rows
Not yet / Just starting
Need some help
Need little help
Completely
Understanding
Speaking
Reading
Writing
Has your child/teen been taking French lessons?
Please provide more details (for how long, when, where...)
We want to know more about your child/teen! What are their favorite books, activities, hobbies,...?
This information helps our teacher tailor their class, thank you!
Does your child/teen qualify for an IEP or 504 plan?
*
Yes
No
Does your child/teen have any allergy?
*
Yes
No
If yes, which allergies (food, medicine,...)
Health related information (asthma, ...) you would like to share?
Do you want to enroll a second child/teen?
*
Yes
No
Back
Next
Your 2nd child/teen
Every child/teen must understand French very well to be comfortable in their class. Email contact@philaflam.com if it's not the case!
Student name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
How would you rate your child/teen abilities in French?
*
Rows
Not yet / Just starting
Need some help
Need little help
Completely
Understanding
Speaking
Reading
Writing
Has your child/teen been taking French lessons?
Please provide more details (for how long, when, where...)
We want to know more about your child/teen! What are their favorite books, activities, hobbies,...?
This information helps our teacher tailor their class, thank you!
Does your child/teen qualify for an IEP or 504 plan?
*
Yes
No
Does your child/teen have any allergy?
*
Yes
No
If yes, which allergies (food, medicine,...)
Health related information (asthma, ...)
Do you want to enroll a third child/teen?
*
Yes
No
Back
Next
Your 3rd child/teen
Every child/teen must understand French very well to be comfortable in their class. Email contact@philaflam.com if it's not the case!
Student name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
How would you rate your child/teen abilities in French?
*
Rows
Not yet / Just starting
Need some help
Need little help
Completely
Understanding
Speaking
Reading
Writing
Has your child/teen been taking French lessons?
Please provide more details (for how long, when, where...)
We want to know more about your child/teen! What are their favorite books, activities, hobbies,...?
This information helps our teacher tailor their class, thank you!
Does your child/teen qualify for an IEP or 504 plan?
*
Yes
No
Does your child/teen have any allergy?
*
Yes
No
If yes, which allergies (food, medicine,...)
Health related information (asthma, ...)
Do you want to enroll a fourth child/teen?
*
Yes
No
Back
Next
Your 4th child/teen
Every child/teen must understand French very well to be comfortable in their class. Email contact@philaflam.com if it's not the case!
Student name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
How would you rate your child/teen abilities in French?
*
Rows
Not yet / Just starting
Need some help
Need little help
Completely
Understanding
Speaking
Reading
Writing
Has your child/teen been taking French lessons?
Please provide more details (for how long, when, where...)
We want to know more about your child/teen! What are their favorite books, activities, hobbies,...?
This information helps our teacher tailor their class, thank you!
Does your child/teen qualify for an IEP or 504 plan?
*
Yes
No
Does your child/teen have any allergy?
*
Yes
No
If yes, which allergies (food, medicine,...)
Health related information (asthma, ...)
Do you want to enroll a fifth child/teen?
*
Yes
No
Back
Next
Your 5th child/teen
Every child/teen must understand French very well to be comfortable in their class. Email contact@philaflam.com if it's not the case!
Student name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
Non Binary
How would you rate your child/teen abilities in French?
*
Rows
Not yet / Just starting
Need some help
Need little help
Completely
Understanding
Speaking
Reading
Writing
Has your child/teen been taking French lessons?
Please provide more details (for how long, when, where...)
We want to know more about your child/teen! What are their favorite books, activities, hobbies,...?
This information helps our teacher tailor their class, thank you!
Does your child/teen qualify for an IEP or 504 plan?
*
Yes
No
Does your child/teen have any allergy?
*
Yes
No
If yes, which allergies (food, medicine,...)
Health related information (asthma, ...)
Back
Next
Emergency information
Emergency phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized persons to pick up the student after school
1st parent Employer name
*
2nd parent Employer name
In case of medical emergency involving my child, I understand every effort will be made to contact me and other emergency contact people whom I have provided. In any event, I hereby authorize PhilaFLAM, and each of their organizers, directors, members, employees, agents and volunteers to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities. I hereby release PhilaFLAM from any liabilities arising out of any medical procedure described above, including but not limited to civil, criminal and financial responsibilities.
*
Yes
No
Back
Next
Registration confirmation
I agree to share my contact information for the directory and carpooling
*
Yes
No
Video/Photo: I hereby grant PhilaFLAM the right and permission to use photographs and/or video recordings of me and/or my child on PhilaFLAM.com and other websites and in publications, promotional flyers, educational materials, derivative works, included Internet, for educational, public relations or promotional purposes without compensation to me.
*
Yes
No
Submit
Should be Empty: