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Child's First Name (required)

Child's Last Name (required)

Child's Nick Name (optional)

Child's Birthday (required)

FemaleMale

Current School

Current Grade

Mom's Name (required)

Mom's Phone (required)

Mom's Email (required)

Dad's Name (required)

Dad's Phone (required)

Dad's Email (required)

Address

Please list the dates and times you're signing up for

Please list any allergies or medical conditions that Quentz Bilingual Academy should be aware of:

Please do not send your child to our school with a fever or bad cough. Germs spread quickly through the classroom and we want to try and reduce as much illness as possible. If your child must miss our school due to illness, we will save any important work for your child for when he/she returns. No Child with a fever of 101F or above is allowed to stay in our school. Physician to be called, if needed, in emergency (we will call 911 when necessary)

Doctor's Name (required)

Doctor's Phone (required)

What would you like your child to accomplish through the Quentz Bilingual Program

Name/s of Authorized Person/s to Pick Up Child (photo id may be required)

Quentz Bilingual Academy teachers occasionally take photographs or videos of students in the classroom.
Yes, I give my permission for my child to be photographed or videotaped during activities at Academy or on field trips.No, I do not want my child photographs to be taken.

Cancellation and Refund Policy: No refunds after used care/classes. No Refunds for individual missed classes.
I understand and accept the cancellation policy.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Quentz Bilingual Academy, their employees, officers and agents, from any loss, cost, damage, accident, illness, or death occurring and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in Quentz Bilingual Academy's curricular programs or activities.
I/we acknowledge that we have read and understand this document and accept the risk and responsibility.

When you click on the button below, you will receive an email confirmation. Please follow the instructions in the email to complete the registration.