Kids’ Program Registration Form

Non refundable deposit: $75

Referred by:

Please Choose class/camp option(s):

Saturday
Saturday 10 am - 12 pm Saturday 12 pm - 2 pm Saturday 2:15 pm - 4:15 pm

Thursday

Thursday 4:30 pm - 6:30 pm

FEES PAYMENT PLAN:

Fees Payment Plan

Installment plan: $105 + GST monthly installments over 5 months, 1st payment @ time of registration, + $75 non-refundable deposit.

Easy plan: $255 +GST & the rest over 4 months ( $63.75/month), + $75 non-refundable deposit.

Full Payment: $495.00 + GST payable at time of registration, + the non-refundable deposit ($75)

YOUR EMAIL (Must be filled):

email address

STUDENT INFORMATION:

CHILD 1

First

Last

Date Of Birth (MM/ DD/ YY)

CHILD 2

First

Last

Date Of Birth (MM/ DD/ YY)

CHILD 3

First

Last

Date Of Birth (MM/ DD/ YY)

Language(s) spoken at home:

Language field

PARENT (LEGAL GUARDIAN) INFORMATION

Father (or Legal Guardian): *

Surname, First Name

Father's Address

Number/Street/City/Province/Postal Code

Email Address

Cell Phone

Occupation (Optional)
(for field trip or volunteer purposes)

Mother (or Legal Guardian):*

Surname, First Name

Mother's Address

Number/Street/City/Province/Postal Code

Email Address

Cell Phone

Occupation (Optional)
(for field trip or volunteer purposes)

Are parents living together?

living together
Yes No

If no, who has custody of child during program hours?

custody

Is there any other information that we should know which would help the teacher work effectively with your child?

EMERGENCY CONTACT INFORMATION (Other than Parents and Guardians)

Name:

Relationship to Child:

Phone:

Allergies:

**** Please fill out the following if it applies to your child:

Medication or Action Taken:
(i.e. Benadryl, Epipen, etc.)

Medication

Additional Notes:

Children must be toilet trained (no diapers or pull-ups).

Class switches are subject to availability

Attendance Policy: Absent students are allowed make up sessions in another class up to 3 classes per term, subject to availability. If the missed class is not available in another day, material and hand outs will be given to the student for self study. Parents are encouraged to revise the missed topics with the students at home.

Please include the following with your registration form:

Completed Installment Payment Plan Agreement or full payment

$75 non-refundable deposit (in addition to class fees)

Withdrawal

30 days' written notice prior to the first day of the program is required to withdraw from Fairouz Academy programs and have the appropriate fees cancelled. Registration fee and installment payment plan administration fee are non-refundable.

We will NOT provide refunds after the start of the program or if registration is cancelled less than 30 days prior to the start of the program, and no prorating of fees will be provided. Those who opt to pay the full program's tuition in advance will not receive a refund on their payment. Parents and Guardians are expected to continue to pay for their monthly payments for the rest of the program regardless of the child no longer attending.

Release of Liability:

Release of Liability:

I hereby consent to the above terms, and hereby recognizes and acknowledges that Fairouz Arabic Language Academy LTD and staff will not be responsible for personal injury or loss. I give permission for the staff at Fairouz Arabic Language Academy LTD. to administer first aid to my child if there is a minor injury. In the event that the injury of my child requires further medical attention and I cannot be located, I hereby consent to Fairouz Arabic Language Academy LTD contacting the above doctor and calling an ambulance if deemed necessary. It is my responsibility for any costs incurred.
Note this is required.

Photo Release:

Photo Release:

I hereby authorize my child's photo to appear in the media or to be used to promote or publicize our programs without compensation. My child’s name and identity will not be revealed. Should I prefer that Fairouz Arabic Language Academy LTD do not photograph my child I will notify Fairouz Arabic Language Academy LTD via e-mail at info@fairouzacademy.org.