Babies & Toddlers - Registration Form

Student type *

Parent 1 Name *

Parent 1 Name

First Name

Last Name

Phone 1 *

Phone 1

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Email Address 1 *

Cell phone for text messages *

Cell phone for text messages

Please inform a cell phone # at which you can be reached in case we need to reschedule a session

(###)

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Parent 2 Name

First Name

Last Name

Phone 2

(###)

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Email Address 2

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's 1 Name *

Child's 1 Name

First Name

Last Name

Child's 1 Date of Birth *

Child's 1 Date of Birth

YYYY

Child's 2 Name

First Name

Last Name

Child's 2 Date of Birth

YYYY

Sessions *

WAIVER *

I do hereby release (for myself, my executors and administrators) and wave any and all rights to claims for damages arising from illness, accident or occurrence caused by or as a result of my child’s participation or connection with Brazil Ahead (Brazil Ahead Language School, Inc.), its instructors, agents, representatives and/or facilities. Brazil Ahead Language School, Inc. shall not be held responsible by me for any loss or theft of my or my child’s personal items.

I declare that I have read and understood the foregoing statement. I also declare that my child is in good health.

STUDENT PHOTO RELEASE *

I authorize Brazil Ahead to photograph, videotape or interview my child(ren) and to use such photos, videos or interviews, in some of its promotional materials, including web sites, Facebook pages and newsletters, flyers, posters and newspapers (when in group photos) and other materials in print, audio, electronic or visual media. In addition, I voluntarily waive any right, cause of action or demand of any kind whatsoever resulting from Brazil Ahead’s photograph or interview of my child(ren) from which any liability may or could accrue to Brazil Ahead. I also understand that Brazil Ahead will not give me or my child(ren) any compensation for using my child(ren)’s photograph or interview in its promotional materials. Thus, by signing this document, I waive any rights to any compensation now or in the future.

I agree

I do ALSO agree - that my child photos, videos or interviews might be used, as well as the name of my child, in any of its promotional materials, including its brochures and advertisements materials in print, audio, electronic or visual media, when in group photos.

I do NOT agree - please do not photograph my child. I understand this will exclude my child from progress videos, photo updates on your website etc.

SCHOOL POLICY *

I have read the school policy below and agree to the terms and conditions contained in the policy. I am aware that the schedule I have chosen is subject to change and classes are not confirmed until at least four (4) students are enrolled.

I agree

PLEASE READ: SCHOOL POLICY