Full Immersion Thanksgiving Camp Registration Mission Hills / Balboa

Customer Details:

Parents Name*

First NameLast Name

Parents Phone Number*

Parents E-mail

example@example.com

Students Name

First NameLast Name

Students Age *

Students Gender

MaleFemale

Level of Experience with Foreign Language

BeginnerIntermediateAdvanced

Grade *

Language of Choice

EnglishSpanish

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 Number

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

YesNo

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.*

I Agree

Signature

My Products

Full Day Thanksgiving Camp Early Bird Discount$375.00 Product Image

Full Day Thanksgiving Camp Early Bird Discount$375.009:00 AM - 4:00 PM | The fee includes Camp T-Shirt, Cooking, Lunch, Camp Supplies, Field Trips, STEAM & One of a kind Full Immersion Experience!

$375.00 Quantity

Half Day Thanksgiving Camp Early Bird Discount$215.00 Product Image

Half Day Thanksgiving Camp Early Bird Discount$215.009:00 AM - 12:00 PM | Fee includes Camp T-Shirt, Cooking, Lunch, Camp Supplies & Fieldtrips & One of a kind immersive Experience.

$215.00 Quantity

Single Day or Drop-In Option *Early Bird Pricing Product Image

Single Day or Drop-In Option *Early Bird PricingSingle Day or Drop In option is strictly FULL DAY schedule ONLY from 9:00AM to 4:00PM. ***Fee includes camp T-Shirt, Field Trips, Cooking, Lunch, Camp Supplies, STEAM & One of a kind immersive experience.

$215.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration