Arabic After School Program

Parent/Guardian Name *

First

Last

Parent/Guardian phone number *

Email *

Camper 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 (Pre-novice): Has a basic background and some knowledge of the letters. Mon, Wed 5:00-6:30
Level 2 (Novice 1-2): Reads simple words and sentences. Tue, Thu 5:00-6:30

the and Checkout

Pay per month or the whole program *

Regestration Fee *

One time payment per course for txtbook, materials, and regestration 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)? *

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

I understand that participation in camp 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 will provide a snack during camp, but families are responsible for sending lunch with their child each day. 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 10-minute grace period will be allowed. If my child is picked up more than 10 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