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Que Tal TEST PAGE
Student Registration Form GRAVITY FORMS TEST
"
*
" indicates required fields
Step
1
of
3
33%
Parent/Guardian, primary
Title
*
Select One
Ms.
Mrs.
Mr.
Mx.
Dr.
Name
*
First
Last
Primary Email
*
Primary Phone
*
Primary Parent Address
*
Street Address
Address Line 2
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Vermont
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Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is there a secondary parent/guardian to add?
*
Yes
No
Parent/Guardian, secondary
Title
*
Select One
Ms.
Mrs.
Mr.
Mx.
Dr.
Name
*
First
Last
Email
*
Phone
*
Always include Parent 2 in emails?
Not necessary
Yes
Student Information
Name
*
First
Last
School
*
Select One
Birchview - Wayzata
Gleason Lake - Wayzata
Greenwood - Wayzata
Kimberly Lane - Wayzata
Meadow Ridge - Wayzata
Northwoods - Wayzata
Oakwood - Wayzata
Plymouth Creek - Wayzata
Sunset Hill - Wayzata
Countryside - Edina
Creek Valley - Edina
Highlands - Edina
Grade in Fall
*
Select One
Kindergarten
Other (Only if authorized by Qué Tal staff)
Which Grade?
*
1st
2nd
3rd
4th
5th
6th
7th
8th
Gender
*
F
M
Other
Student Birthdate
*
MM slash DD slash YYYY
Allergies/Special Concerns
After-Class Program "El Club"
*
No - My child will be picked up
5:30 - Greenwood, Oakwood
5pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Sunset Hill, Gleason Lake, Birchview
6pm EDINA
Fridays After-Class Program "El Club" - WAYZATA ONLY
*
Not necessary
5:30 - Greenwood, Oakwood
6pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Sunset Hill, Gleason Lake, Birchview
Add a Second Student?
*
Yes
No
Student 2
Name
*
First
Last
School
*
Select One
Birchview - Wayzata
Gleason Lake - Wayzata
Greenwood - Wayzata
Kimberly Lane - Wayzata
Meadow Ridge - Wayzata
Northwoods - Wayzata
Oakwood - Wayzata
Plymouth Creek - Wayzata
Sunset Hill - Wayzata
Countryside - Edina
Creek Valley - Edina
Highlands - Edina
Grade in Fall
*
Select One
Kindergarten
Other (Only if authorized by Qué Tal staff)
Which Grade?
*
1st
2nd
3rd
4th
5th
6th
7th
8th
Gender
*
F
M
Other
Student Birthdate
*
MM slash DD slash YYYY
Allergies/Special Concerns
After-Class Program "El Club"
*
No - My child will be picked up
5:30 - Greenwood, Oakwood
5pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Sunset Hill, Gleason Lake, Birchview
6pm EDINA
Fridays After-Class Program "El Club" - WAYZATA ONLY
*
Not necessary
5:30 - Greenwood, Oakwood
6pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Sunset Hill, Gleason Lake, Birchview
Add a Third Student?
*
Yes
No
Student #3
Name
*
First
Last
School
*
Select One
Birchview - Wayzata
Gleason Lake - Wayzata
Greenwood - Wayzata
Kimberly Lane - Wayzata
Meadow Ridge - Wayzata
Northwoods - Wayzata
Oakwood - Wayzata
Plymouth Creek - Wayzata
Sunset Hill - Wayzata
Countryside - Edina
Creek Valley - Edina
Highlands - Edina
Grade in Fall
*
Select One
Kindergarten
Other (Only if authorized by Qué Tal staff)
Which Grade?
*
1st
2nd
3rd
4th
5th
6th
7th
8th
Gender
*
F
M
Other
Student Birthdate
*
MM slash DD slash YYYY
Allergies/Special Concerns
After-Class Program "El Club"
*
No - My child will be picked up
5:30 - Greenwood, Oakwood
5pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Sunset Hill, Gleason Lake, Birchview
6pm EDINA
Fridays After-Class Program "El Club" - WAYZATA ONLY
*
Not necessary
5:30 - Greenwood, Oakwood
6pm - Meadow Ridge, Plymouth Creek, Northwoods, Kimberly Lane
6pm - Sunset Hill, Gleason Lake, Birchview
Emergency Contacts
Other than parent(s) and/or guardian(s). In case of an emergency, we always attempt to reach the parent(s) or guardian(s) first.
Primary Emergency Contact Name
*
First
Last
Primary Emergency Contact Phone
*
Secondary Emergency Contact Name
*
First
Last
Secondary Emergency Contact Phone
*
How did you hear about Qué Tal?
*
Qué Tal parent
Kindergarten Round Up
Postcard or Mailing
Online Search
Preschool
Other
Registration Agreement
PLEASE NOTE
*
By checking the box, I am agreeing to the above terms and conditions.
EMERGENCY INFORMATION
In case of a serious accident/injury/illness or other emergency, I hereby authorize Qué Tal Language Program to call “911” BEFORE notifying me or my physician. (In these cases, please know that your child will be taken to the nearest source of medical care.) If an ambulance is necessary, I understand that the Qué Tal Language Program will not be held responsible for any costs this action may incur. In the event I or my emergency contacts cannot be reached, I’ve authorized all medical and surgical treatment, medications, X-ray, laboratory, anesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child(ren) on my/our behalf. I understand that the Qué Tal Language Program will not be responsible for any costs this action may incur.
PROGRAM GUIDELINES
Further, I understand and accept the guidelines and requirements found in the Parent Handbook with respect to attendance, behavior and transportation. I am registering my child for the full year of Spanish classes and I am expected to pay the full registration fee. My tuition payments are non-refundable if I should decide to remove my child from the program or if my child is asked to leave due to continuing behavior problems or excessive absences.
RE-ENROLLMENT POLICY
The school will automatically re-enroll active students in the program for each subsequent school year and the family will be responsible for paying the corresponding tuition. An opportunity to withdraw from the program will be provided during the annual registration period for the upcoming school year. If the student is not withdrawn within the specified time frame, the refund will be subject to the Refund Policy found in the Parent Handbook on the website.
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