after school enrollment form

after submitting this form, a confirmation message will be sent to your email and you will be redirected to the tuition payment. you may add more than one program to the cart.

If you’re enrolling more than one child please fill out the information of all kids and add to the cart as many programs as the kids that will be attending.

Parent Full Name

Phone

parent Full Name

Phone

Child Physical Address

Pick up authorized person (please select multiple if more than one)

Mother Father Other

Pick up authorized person (if selected other)(may be more than 1)

Emergency contact other than parents

Emergency contact phone number

Child Full Name

Child Date of Birth

Child’s age

allergies

Primary doctor

Phone

2nd Child Full Name

2nd Child Date of Birth

2nd Child’s age

allergies

Primary doctor

Phone

Additional questions, notes or medical conditions

desired starting date

if the 1 hour try out class was selected please write the class you would like to try and the date

if the selected program is reading & writing or math, Please Select the day your child will be joining us. (select multiple if the purchased programs are for more than one day/hour)

Reading & Writing Mondays 3:45pm – 4:45pm Math Mondays 4:45pm – 5:45pm Reading & Writing Wednesdays 3:45pm – 4:45pm Math Wednesdays 3:45pm – 4:45pm Reading & Writing Thursdays 3:45pm – 4:45pm Math Thursdays 3:45pm – 4:45pm

if your child will be joining the after school pick up with care please make sure the school has been notified and write bellow the school your child will be picked up from, as well, add the tuition for the pick up add on to the order on the next step along with the program tuition for payment.

permission to photograph the child and use pictures for social media/marketing

yes no

IMPORTANT: PLEASE READ CAREFULLY ALL THE INFORMATION OFFERED ABOUT THE PROGRAM. THIS INCLUDES: THE TUITION, THE ENROLLMENT AND PAYMENT PROCESS .

PLEASE READ CAREFULLY AND ACCEPT THE TERMS: I state that I have read, understood and accept the terms and condition of Fasttrack-Languages. * Tuition is subject to change. Please check rates at the time of enrollment. * A 60 days' un-enrollment notice is required for all students. NO EXCEPTIONS. * Enrollment/Application forms for the program your child will be attending are required before each child's enrollment is completed or starting date. * Our school offers placement all year round as a rolling admission's school. * The Fasttrack-Languages center is well childproofed and the children are consistently well supervised. However, accidents do happen. The undersigned(s) assume(s) all risk of injury to the child associated with participation in any program that our school offers.