After School Program Enrollment Form

Please complete and submit one form per student being enrolled in the After School Program.

Parent's Name*

First NameLast Name

Parent's Phone Number*

Area CodePhone Number

Parent's Email*

Student's Name*

First NameLast Name

Student's Age*

Gender*

FemaleMale

Grade:*

Homeroom #:*

Level of Experience with Foreign Language*

BeginnerIntermediateAdvanced

Language of Choice*

SpanishMandarinESL

Please describe the area where your child needs most support with language learning.

Special instructions? (IEP's, Allergies, etc.) Please be as specific as possible.*

Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.

Authorized Person to Pick Up:*

First NameLast Name

Authorized Person to Pick Up:

First NameLast Name

Phone #*

Emergency Contact Person:*

First NameLast Name

Phone #*

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 that this would be on print, online, and/or video images of in-program activities.*

YesNo

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, I authorize a representative of Bilingual Kids to obtain immediate care deemed necessary by licensed medical personnel. I have read and fully understand these terms and I sign it voluntarily.*

I Agree

Signature*

My Products

Doyle Elementary (Winter Session)$195.00

Doyle Elementary (Spring Session)$240.00

8 Weeks Session | Every TUESDAYS | 2:05PM - 3:05PM | March 25, 2025 - May 20, 2025 | Room: B4

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Total $0.00

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After School Program Registration Form