Blue Giraffe of Washington DC 2025-2026 Registration

Blue Giraffe of Washington DC 2025-26 Registration

Russian speakers programs
Child Information
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Grade (optional)
Information we may need to know about the child (including food allergies). Special needs: (physical; developmental; behavioral/emotional; sensory). This information helps our staff to do their best to accommodate all of our students particular needs.
Parent/Legal Guardian Name

First NameLast Name
Parent/Legal Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact 1 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 1 Phone Number

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 2 Phone Number

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child's art works appear in to be used by Blue Giraffe in printed and/or electronic media, including the Blue Giraffe's website and FB page.
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by Blue Giraffe in printed and/or electronic media, including the Blue Giraffe website and FB page.
Late Pick-Up Policy
LATE PICK-UP POLICY FEE AND PROCEDURE: Up to 15 minutes: Automatic flat $15.00 late fee is charged. After 15 minutes: Automatic flat $25.00 late fee is charged
Understanding the Program
By clicking the box below, I hereby acknowledge that there are NO refunds or make-ups for missed classes, except Art classes. I understand that this is a program that exist as one whole program and can not be divided by individual days or classes.
Authorization for Medical Treatment
In the event that parents/guardians named on this form cannot be reached, I authorize officials of the Blue Giraffe Education Center to consent on my behalf, to provide emergency treatment for my child

Registration Fee for New Students$55.00

Total $0.00

Credit Card

Should be Empty:

Blue Giraffe of Washington DC 2025-26 Registration

Child Information

Media Release

Late Pick-Up Policy

Understanding the Program

Authorization for Medical Treatment

Credit Card