Summer Camp Admissions

Summer Camp 2019*
We are excited that you are considering enrolling your child in Spanish Academy Summer Camp(s). You can read more about our summer camps here.
Tuition payment is due at the end of this registration form and the payment is non-refundable and non transferable* .

*We will do our best to allow you to move to another week should something arise, but there is no guarantee that request can be met.
- I have read the statement above and which to proceed

Location*

Buckhead Summer Camp Programs - 2019*
Please choose week(s) of:
June 3
June 10
June 17
June 24
July 22
July 29
Aug 5
East Cobb Summer Camp Programs - 2019*
Please choose week(s) of:
June 3
June 10
June 17
June 24
July 22
July 29
Emory Summer Camp Programs - 2019*
Please choose week(s) of:
June 3
June 10
June 17
June 24
July 22
July 29
Suwanee Summer Camp Programs - 2019*
Please choose week(s) of:
June 3
June 10
July 22
July 29

Is your child a 2 years old?*
2 yr olds and ONLY 2 yr olds can choose 2, 3, or 5 days a week. If your child is OLDER than 2, check NO.
- Yes
- No

2 year old Options
Please indicate how many days you want your 2 yr. old to attend. Please skip if your child is OLDER than 2.
- 2 Days a week
- 3 Days a week
- 5 Days a week

Child's Name (Name Child Goes By):*
First Last
Child's gender*
- Boy
- Girl
Immersion Program*
Is your child currently enrolled in a Spanish Immersion Program?
- Yes
- No
Child's Birth Date*
All children must be be 2 years old by June 1, 2019.

Home Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone Number:*

Parent 1 Name (Primary Contact)*
First Last
Please select relationship to child*
Parent 1 Cell Phone*
Parent 1 Work Phone*
Parent 1 Email*
Parent 2 Name*
First Last
Please select relationship to child*
Parent 2 Cell Phone*
Parent 2 Work Phone*
Parent 2 Email*

Authorized Carpool Pickup
Please list the people that you would like to authorize to pick up your child. We will not release your child, under any circumstance, to anyone other than his/her parents without written permission.
First Carpool Contact
First Last
First Carpool Contact Phone
Second Carpool Contact
First Last
Second Carpool Contact Phone
Emergency Contact
Please list local persons other than regular carpool drivers that we may call in case of an emergency if you cannot be reached and that has permission to pick up your child.
First Emergency Contact Name*
We will contact this person after attempting to contact Parent 1 and Parent 2.
First Last
First Emergency Contact Phone*
Second Emergency Contact Name
First Last
Second Emergency Contact Phone

Medical Information
Child's Physician*
First Last
Physician's Phone Number*
Insurance Company*
Insurance Company Phone Number*
Insurance Group Number*
Insurance Company Address*
Street Address Address Line 2 City State ZIP Code
Health Problems, Allergies, or other important information
Please list any allergies, health concerns, or other important information we should know about your child. Please make sure your child's teachers and the school Director understand the severity of any allergies.
Symptoms displayed when having an allergic reaction:
Emergency Medical Agreement*
Should my child suffer an injury or illness while in the care of The Spanish Academy, and the school is unable to contact me (us) immediately, it shall be authorized to secure medical attention and care for my child as may be necessary. I (we) assume responsibility for payment of services. I (we) agree to keep the school informed of changes in telephone numbers where I (we) can be reached.
- I have read and agree to abide by the policies listed above.
Policies*
*Absolutely no refunds will be made.

*All children enrolled at The Spanish Academy are required to have health insurance.

*Candid pictures and video of children at The Spanish Academy may be used for advertising purposes.
- I have read and agree to abide by the policies listed above.

Your Information
Lastly, please fill out your information and preferred email.
Name*
First Last
Email*

Price*
3 days/week and 2 days/week options are available for 2 year olds ONLY
5 days/week - $200.00
3 days/wk- $125.00 - 2 year olds ONLY
2 days/wk - $85.00 - 2 year olds ONLY
Quantity*
**STOP** READ: Please enter the number of weeks you choose earlier in the sign up process.
Please enter a value between 1 and 7.
Total
$0.00
Coupon
If you are a Spanish Academy employee, please enter employee discount code here:

Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.

Summer Camp Admissions

2 yr olds and ONLY 2 yr olds can choose 2, 3, or 5 days a week. If your child is OLDER than 2, check NO.

Please indicate how many days you want your 2 yr. old to attend. Please skip if your child is OLDER than 2.

Authorized Carpool Pickup

Emergency Contact

Medical Information

Your Information

**STOP** READ: Please enter the number of weeks you choose earlier in the sign up process.

STOP READ: Please enter the number of weeks you choose earlier in the sign up process.