Registration

This is for after-school program families ONLY!

Spanish Club - Registration

* Indicates required field

School Name *

Day and time *

Child's Name *

First

Last

Grade *

Room # *

Teacher Name *

Sibling *

First

Last

Grade *

Room # *

Teacher Name *

Does your child have any allergies? Please describe. *

Does your child have any special needs? *

Parent name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency contact *

First

Last

Phone Number *

Names of people with permission to pick your child up *

Media release

I consent to have photographs and/or videos of my son/daughter for use by Bilingual Butterflies LLC. I understand that any photo/video would be used solely to publicize school programs or to illustrate educational activities. If student's name is used, only their first name and last initial will be published. If I do not consent, I understand I must indicate in writing to info@bilingualbutterflies.com

Choose One *

Yes, I consent No. I do not consent

*Full payment due unless other arrangements have been made.
*Payment may be made via PayPal. We also accept checks or cash before start date.
*Payment plans are possible, please call to discuss.
*Tuition is non-refundable
*We reserve the right to cancel any class due to inclement weather or if enrollment is insufficient.
*If a class is canceled, we will notify you by email

After school dismisses at 4:15pm. Please be on time!

I agree to receiving marketing and promotional materials

Submit

Spanish Club - Registration

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215)987-6358

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