Centro Bilingue de San Miguel Spanish School San Miguel de Allende Guanajuato Mexico - Adults Teenagers and children summer camp

Teenager Registration Form

Fill in the form and click the Preview button, review the information and if everything is ok print the form.

If more than one person will be attending, please fill out and print one form for student.

You need to print this form together with the waiver and mail it along your deposit.

Personal Information

Student Name: Age: Gender: F M

Address:

City: State: Zip:

Country: Phone: Email:

Parents' Information

Father's name:

Work phone: Home phone:

Mother's name:

Work phone: Home phone:

Emergency Contact

Name:

Relation: Phone:

Session Dates

Desired Beginning Date: Ending Date:

School Information (If Applicable)

Years of Spanish: Current school grade level:

Returning student from prior year: Yes No

What kind of extra-curricular activities interest your child (sports, hobbies, etc.)?

Health Information

Health Insurance Provider and Policy Number:

Does your child have any illnesses or allergies that we should know about?

Are there any medications that your child takes on a regular basis?

Are there any foods that your child cannot eat for religious or health reasons?