Tohui Enrollment Form / Language Programs

Enrolling For *

June 1-4 Spanish June 7-11 Spanish June 14-18 Spanish June 21-25 Spanish June 28-July 2 Spanish July 5-9 Spanish July 12-16 Spanish July 19-23 Spanish July 26-30 Spanish

Schedule *

7:00-6:00 8:00-12:00 8:00-3:00

Location *

North Central: 13453 Blanco Rd. LIMITED SEATS AVAILABLE, PLEASE EMAIL BEFORE ENROLLING

Child's Information *

Child's Full Name Child's Date of Birth

Parent / Guardian Information *

Parent / Guardian #1 Full Name Parent / Guardian #2 Full Name

Parent / Guardian E-mail *

Parent / Guardian Phone Number *

Area Code Phone Number

In Case of Emergency if Parent / Guardian Can't be Reached *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

I hereby authorize Tohuí Language Academy to allow my child to leave the facility ONLY with the following persons. Please list name and telephone number(s) for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID. *

I hereby give consent for my child to be transported to the nearest health facility and supervised by Tohuí Language Academy’s employees in case of an emergency *

Yes No

I give consent for the facility to secure any and all necessary emergency medical care for my child. *

Yes No

List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of *

I hereby give permission for images of my child captured at Tohuí Language Academy through video, photo and digital camera, to be used solely for the purposes of the Tohuí Language Academy classroom and promotional materials, and waive any rights of compensation or ownership thereto *

Yes No

I hereby give permission for my child to access internet under the supervision of Tohuí Language Academy’s employees for educational and academic purposes *

Yes No

Medical Authorization and Disclaimer: I acknowledge that there are known, unknown, and unforeseen risks associated with participating in activities conducted by Tohui Language Academy. I willingly assume the risks associated with participation in activities. I agree to hold Tohui Language Academy harmless for any and all injuries, liabilities or damages resulting from the students participation in such activities. *

Clear

I understand ALL fees are NON REFUNDABLE and need to be paid in full before service starts. *

yes

Cancellation policy: A 3 week notice before camper's first day will be required for a 100% refund. A 2 week notice before camper's first day will be required for a 50% refund. *

Agree

I understand that teachers at Tohui create a safe and loving environment in the classroom. GOOD BEHAVIOR is expected on all camps and language classes to maximize learning to all students.

Yes

Payment Information. Tohui will contact you before processing a payment. Your child's registration will be complete when payment has been processed. *

Name On Card Card Number

*

Expiration Date Security Code

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Tohui Enrollment Form / Summer Care