2019 - 20 French Program Registration Form

Student's Name

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Grade:

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Current Daytime School

In which French program has the student been studying?

How many years has your child been in the selected French program?

Does your child speak French at home on a daily basis?

Name of Parents (Guardians)

First NameLast Name

Parent's E-mail Address

Mobile Number

Area CodePhone Number

Other Phone Number

Area CodePhone Number

Please select a program you are interested in:

HEALTH CONDITIONS: If your child suffers from allergies or health conditions requiring special attention like medication; has special needs or learning disabilities that you feel we should know about, please list them:

REFUND POLICY:

WAIVER OF CLAIMS AND INDEMNITY:

By clicking the box, I give permission to the staff of T.E.A to arrange for any emergency medical care. In all cases, attempts will be made to contact the parents first. The participants are responsible for their own medical coverage. I hereby release The Education Academy from all claims arising from the participation of any activity relevant to the French programs offered; I hereby agree to well and sufficiently indemnify and save harmless the Academy and keep the Academy indemnified and harmless of any and all demands, actions, proceedings, liability claims, damages, together with the costs and expenses thereof, that may hereafter at any time be made or brought by or on behalf of my child for any injury, loss, damage, expense and costs sustained or alleged to have been sustained by my child howsoever arising from the aforesaid programs provided.

PUBLICITY: I give permission to T.E.A to take pictures of my child and use them in their publicity

I, the applicant of this registration form, warrant the truthfulness of the information provided in this application. Electronic Signature:

Please type your first and last name

2019 North America French Public Speaking Contest Registration Form