Registration Form
To reserve seats please complete and submit the form.
1st Guardian Full Name
*
First Name
Last Name
Relationship to the child
*
Phone Number
*
-
Area Code
Phone Number
E-mail address
*
2nd Guardian Full Name
First Name
Last Name
Relationship to the child
Phone Number
-
Area Code
Phone Number
E-mail address
Address
*
Number of kids
*
Name of child 1
*
First Name
Last Name
Age of child 1
*
Does the child have any food allergy or a medical condition that needs special attention? Please specify.
Start date
*
-
Day
-
Month
Year
Date Picker Icon
Name of child 2
First Name
Last Name
Age of child 2
Does the child have any food allergy or a medical condition that needs special attention? Please specify.
Start date
-
Day
-
Month
Year
Date Picker Icon
Name of child 3
First Name
Last Name
Age of child 3
Does the child have any food allergy or a medical condition that needs special attention? Please specify.
Start date
-
Day
-
Month
Year
Date Picker Icon
Permission to use of Photos: I hereby grant my permission to ArabiCa Learning Center to use images of my son/daughter. Such use includes the display of photos for educational purposes, broshures, newsletters, videos, and digital images used on ArabiCa's website and social media pages such as Facebook and Instagram.
I grant permission for the use of my kid's photo to be used
I do not grant permission for the use of my kid's photo to be used
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone number
*
-
Area Code
Phone Number
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Are you interested in Saturday classes or Monday-Thursday Classes?
Saturday
Monday- Thursday
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