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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
Students Name:
Age:
Gender:	F M
Address:
City:
State:
Zip:
Country:
(Area Code) + Phone:
Email:
Parents Informations
Father's Name:
Work phone:
Home phone:
Mother's Name:
Work phone:
Home phone:
Emergency Contact
Name:
Relation:
(Area Code) + Phone:
Desired Dates
Beginning Date:
Ending Date:
School Information
Years of Spanish:
Current School Grade Level:
Returning student from prior year:	Yes No
Extra Information
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?