Arabic After School Program

Parent/Guardian Name *

First

Last

Parent/Guardian phone number *

Email *

for concerns, Birth

Student Name *

First

Last

Date of Birth *

Emergency Contact Name *

First

Last

Emergency Contact phone number *

Are there any allergies, health concerns, or special needs we should be aware of? *

Choose the Group *

Level 1: (Preparatory): For students who have no prior knowledge of Arabic. Mon 5:00-6:30
Level 2 (Pre-novice): For students who have a basic background and some knowledge of the letters. Thu 5:30-7:00
Level 3 (Novice 1-2): For students who can reads simple words and sentences. Wed 5:00-6:30.
Level 4 (Novice 2–3) For students who can read and understand simple to intermediate words and sentences related to everyday life. Tue 5:00–6:30 PM

Pay per month or the whole program *

Registration Fee *

One time payment per course for textbook, materials, and Registration Fee. - $50.00

Total

$0.00

Do you allow Lingo Dice to use photos/videos of your child only for the institute marketing purpose (website, flyers, and social media)? *

Class Pickup, Waiver & Policy Form (Check all of them) *

I understand that participation in class activities may involve ordinary risks, including minor injuries, accidents, illness, allergic reactions, or other unexpected incidents. I agree that Lingo Dice, its owners, instructors, staff, volunteers, contractors, and representatives will not be held responsible for ordinary risks associated with participation, except in cases of gross negligence, willful misconduct, or intentional wrongdoing.
In case of emergency, I authorize Lingo Dice staff or representatives to contact emergency services and/or seek emergency medical or dental care for my child if I cannot be reached immediately. I understand that I am responsible for any medical, dental, ambulance, emergency, or related costs incurred for my child’s care.
I understand that Lingo Dice doesn't provide a snack during class, but families are responsible for sending snack if needed. I also understand that Lingo Dice cannot guarantee an allergen-free environment.
I understand and agree that my child must be picked up on time at the scheduled dismissal time for their program. A 5-minute grace period will be allowed. If my child is picked up more than 5 minutes late, I agree to pay a late pickup fee of $5 for every 5 minutes of delay.
I, the undersigned parent or legal guardian, confirm that I have read, understood, and agree to the Lingo Dice Policies and Terms available at www.lingodice.com/terms-and-conditions

Checkout *

Arabic After School Program Registration Form