Child's First Name (required)

    Child's Last Name (required)

    Child's Nick Name (optional)

    Child's Birthday (required)

    FemaleMale

    Current School

    Parent's Name (required)

    Parent's Phone (required)

    Parent's 2nd Phone (required)

    Parent's Email (required)

    Address (required)

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

    Please do not send your child to our camp 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 camp 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 the camp. Physician to be called, if needed, in emergency (we will call 911 when necessary)

    Doctor's Name (required)

    Doctor's Phone (required)

    Name/s of Authorized Person/s to Pick Up Child (required)

    Camp Dates:
    9/23,9/30,10/7,10/12,10/14,10/19,10/21,10/26,10/28,11/2,11/4,11/9,11/16,11/18,11/30,12/2,12/7,12/9,12/14,12/16

    Select Camp Dates All 11 Wednesdays for $239 (you get 20% or $58 off for this option)All 9 Mondays for $195 (you get 20% off for this option)9/23/2015($27)9/30/2015($27)10/7/2015($27)10/12/2015($27)10/14/2015($27)10/19/2015($27)10/21/2015($27)10/26/2015($27)10/28/2015($27)11/2/2015($27)11/4/2015($27)11/9/2015($27)11/16/2015($27)11/18/2015($27)11/30/2015($27)12/2/2015($27)12/7/2015($27)12/9/2015($27)12/14/2015($27)12/16/2015($27)

    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 taked.

    Cancellation and Refund Policy: No refunds after used 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.