Child registration

REQUIRED FIELDS*
FATHER'S FIRST NAME*
 


FATHER'S LAST NAME*
 


MOTHER'S FIRST NAME*
 


MOTHER'S LAST NAME*
 


EMAIL*
 


STREET ADDRESS*
 


CITY*
 

 

STATE*
 

 

ZIP*
 

 

COUNTRY*
 

 

HOME PHONE*
 

 

Work Phone
 

 

Fax
 

 

NATIONALITY*
 

 

Will a parent be attending the adult immersion classes on the same weeks as the child?*
 Yes No 

 

Parent's Occupation
 

 

Emergency Contact Name & Phone Number
 

 

How did you hear about us?
 

 



 

CHILD INFORMATION


Child 1

Name
 


Child 1 Age and Date of Birth
 


Sex
 Female Male
 



ESTIMATED LANGUAGE LEVEL*
Beginning Intermediate Advanced 
 


Special Interest
 


Child 2

Name
 


Child 2 Age and Date of Birth
 


Sex
 Female Male 

 


ESTIMATED LANGUAGE LEVEL*
 Beginning Intermediate Advanced
 


Special Interest
 



Child 3

Name
 


Child 2 Age and Date of Birth
 


Sex
 Female Male 

 


ESTIMATED LANGUAGE LEVEL*
 Beginning Intermediate Advanced
 


Special Interest
 





PROGRAM INFORMATION---Camp Catalina Children’s Programs
(Note: Camp sessions begin on Mondays and end on Fridays.) 

 

 



Course Start Date
 


Course End Date
 




Number of weeks of study
 



Reason for choosing school:
 





Expectations:
 



Please type the numbers and letters: 


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