💬 Speak, Play & Learn Spanish Registration Form

💬 Speak, Play & Learn Spanish Registration Form

Fall Season Class
Student Information
Student's Name

First NameLast Name
Student's Age
Grade
Level of Experience with Foreign Language
Language of Choice
Please describe the areas of support that needed for language learning in the target language of choice
Special instructions? (IEP's, Allergies, etc.) Please be as specific as possible
Parent/Guardian Information
Parent's Name

First NameLast Name
Parent's Phone Number
Format: (000) 000-0000.
Email
Authorized Person to Pick-Up
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Emergency Information
Emergency Contact Person:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
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.

💬 Speak, Play & Learn in Spanish

15 weeks Session

Every Tuesday 1:30pm - 3:30pm

Sept 1 - Dec 15

$600.00

Enter coupon

Total

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Informed Consent and Acknowledgement

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.
Signature
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Student Information