ICAN IGBO LEARNING PROGRAM Registration Form

IGBO LEARNING PROGRAM

Online Event Registration
Do you speak Igbo?

Do your children speak or write Igbo?

Do you want your children/ adult speak or write IGBO?

IGBO COMMUNITY ASSOCIATION OF NIGERIA is giving you an opportunity for you to learn and write Igbo.

On January 19th 2019 starting from 12 noon, the Committee on Igbo learning class will begin registration of candidates for Igbo learning class.

For a family registration is $100, individual is $50.00

Venue is Igbo center for culture and educational center, 2425 Gus Thomasson Road Road, Mesquite Texas

For more information

Contact: Mrs. Diana Aguwa
817-521-4495 ( Chairman person)

Sir Ben Ndukwe ( Vice President) 9724672981
STUDENTS' Full Name *

First Name Last Name
STUDENT'S AGE
OPTIONAL FOR ADULTS
DATE OF BIRTH

Month Day Year
OPTIONAL FOR ADULTS
E-mail
Phone Number

Area Code Phone Number
STUDENT'S SCHOOL
OPTIONAL FOR ADULTS
FATHER'S Full Name

First Name Last Name
MOTHER'S Full Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
EMERGENCY CONTACT(S)
EMERGENCY CONTACT (1)
OPTIONAL FOR ADULTS
EMERGENCY CONTACT (1) Phone Number

Area Code Phone Number
EMERGENCY CONTACT (2)
OPTIONAL FOR ADULTS
EMERGENCY CONTACT (2) Phone Number

Area Code Phone Number
IN CASE OF EMERGENCY DO YOU AUTHORZIE THAT YOUR CHILD BE TAKEN TO NEAREST HOSPITAL *

YES NO
DOCTOR'S NAME
OPTIONAL FOR ADULTS
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
I UNDERSTAND THAT MY CHILD SHOULD NOT BE BROUGHT TO SCHOOL IF SICK. I UNDERSTAND THAT I AM RESPONSIBLE FOR THE SAFTY AND TRANSPORTATION OF MY CHILD AFTER SCHOOL

A CHILD NOT PICKED UP 15 MINUTES AFTER SCHOOL ENDS ON SATURDAY WILL BE CHARGED $1.00 PER MINUTE THEREAFTER.

IF A CHILD IS NOT PICKED UP AFTER ONE HOUR AFTER SCHOOL, THAT CHILD WILL BE HANDED OVER TO THE CITY OF DALLAS POLICE.

THE INSTRUCTOR OR ICAN INC. WILL NOT ASSUME RESPONSIBILITY OF ANY CHILD NOT PICKED UP AFTER 15 MINUTES AFTER THE CLASS IS OVER.
Full Name *

First Name Last Name
Date

Month Day Year
Date
PARENT'S / GUARDIAN SIGNATURE

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Enter the message as it's shown *
SPONSORED BY

gbo Community Association of Nigeria
2425 Gus Thomasson Road
Mesquite, Texas 75150
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