Access and Update Your Family’s Information

New User RegistrationChoose a Username*

Set Your Password*

First Name*

Last Name*

Email*

Primary Phone*

Secondary Phone*

Your Address*

City*

State*

Zip*

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 Email (Enter if second parent would like to receive messages from Que Tal.)

Parent/Guardian #2 Address

Parent/Guardian #2 City

Parent/Guardian #2 State

Parent/Guardian #2 Zip

Student #1 First Name*

Student #1 Last Name*

Student #1 School*

Student #1, Grade in Fall*

Student #1 Allergies/Special Concerns*

Student #2 First Name

Student #2 Last Name

Student #2 School

Student #2, Grade in Fall

Student #2 Allergies/Special Concerns

Student #3 First Name

Student #3 Last Name

Student #3 School

Student #3, Grade in Fall

Student #3 Allergies/Special Concerns

Name of Primary Emergency Contact *

Primary Emergency Contact Phone*

Name of Secondary Emergency Contact*

Secondary Emergency Contact Phone*

Name of Child's Physician*

Insurance Provider*

Policy Number*

Insurance Phone*

By checking the box, I am agreeing to Que Tal's terms and conditions.*

I would like to register the children listed above for:*

*Required field