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:

YYYY

Current grade (if applicable):

Current school (if applicable):

STUDENT HEALTH INFORMATION

Allergies or other medical concerns:

There is no need to complete this section if your child is learning via Zoom.

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:

After School French Registration:Advanced Class

After School French Registration:
Advanced Class