2019 - 20 French Program Registration Form

2019 North America French Public Speaking Contest Registration Form

Fill out the form carefully for registration.
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?*

CoreImmersionExtendedPrivate School/Catholic SchoolOther
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:*

French Public Speaking Contest ($100) - Participants will be categorized by level and age group. Beginner French to Advanced French levels - (Dec. 14 at 2 pm - Langstaff CC. )French Public Speaking Training Sessions ($45/class) - 5 sessions (Nov. 9, 16, 23, 30 and Dec. 7, 3:00-4:30 pm - Langstaff CC)
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:*

By clicking the box, I understand that the French Public Speaking Contest is NON-REFUNDABLE. Students can withdraw from the training sessions at any time. A $20 cancellation fee will be applied.
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*

YES, I agree to have my child's picture taken.NO, I do not agree.
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
Should be Empty:

2019 North America French Public Speaking Contest Registration Form