Academic Enrichment — La petite ecole

After School French Registration:
Advanced Class

All questions with an asterisk (*) are required.

STUDENT INFORMATION

Desired Session:

Child's Name

First Name

Last Name

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender:

Birthdate:

MM

DD

YYYY

Current grade (if applicable):

Current school (if applicable):

PARENT 1 INFORMATION

Primary Contact

Name:

First Name

Last Name

Cell phone:

(###)

###

####

Home phone:

(###)

###

####

Email:

How did you hear about La petite école?

Comments:

PARENT 2 INFORMATION

Secondary Contact

Name:

First Name

Last Name

Cell phone:

(###)

###

####

Home phone:

(###)

###

####

Email: