Blue Giraffe of Washington DC 2024-2025 Registration

Blue Giraffe of Washington DC 2024-25 Registration

Russian speakers programs
Child Information
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Grade (optional)
Information we may need to know about the child (including food allergies). Special needs: (physical; developmental; behavioral/emotional; sensory). This information helps our staff to do their best to accommodate all of our students particular needs.
Parent/Legal Guardian Name*

First NameLast Name
Parent/Legal Guardian Name

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 2 Phone Number*

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child's art works appear in to be used by Blue Giraffe in printed and/or electronic media, including the Blue Giraffe's website and FB page.*

I AgreeI Disagree
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by Blue Giraffe in printed and/or electronic media, including the Blue Giraffe website and FB page.*

I AgreeI Disagree
Late Pick-Up Policy
LATE PICK-UP POLICY FEE AND PROCEDURE: Up to 15 minutes: Automatic flat $15.00 late fee is charged. After 15 minutes: Automatic flat $25.00 late fee is charged*

I Agree
Understanding the Program
By clicking the box below, I hereby acknowledge that there are NO refunds or make-ups for missed classes, except Art classes. I understand that this is a program that exist as one whole program and can not be divided by individual days or classes.*

I Agree
Authorization for Medical Treatment
In the event that parents/guardians named on this form cannot be reached, I authorize officials of the Blue Giraffe Education Center to consent on my behalf, to provide emergency treatment for my child*

I Agree
Signature*

Clear

Registration Fee for New Students$55.00

Total $0.00

Credit Card

Should be Empty:

Blue Giraffe of Washington DC 2024-25 Registration

Child Information

Media Release

Late Pick-Up Policy

Understanding the Program

Authorization for Medical Treatment

Credit Card