PARENT'S CONTACT INFORMATION

1. Parent's First name

1. Parent's Last name

2. Parent's First Name

2. Parent's Last Name

Email

Phone

STUDENT'S INFORMATION

MEDIA RELEASE

From time to time, we capture photos and videos during our classes to showcase student creativity, highlight learning experiences, and promote our programs through flyers, websites, and social media.

Please review the information below and select your preferred option regarding the use of your child’s image.

MEDIA RELEASE (CHOOSE ONE)

YES, I give permission for my child to be photographed or recorded during class or program-related activities. I understand that these images or videos may be used in promotional materials, websites, social media, or other educational-related platforms.

NO, I do not give permission for my child to be photographed or recorded during class or program-related activities. I understand that staff will ensure my child is not included in any media content.

School Name

Wharton Dual Language Academy

Child's First Name

Child's Last Name

Grade

Teacher Name

Any Allergy's

Be prepared to present your I.D. and school assigned car tag # for verification at the time of pick up.

Choose an option

Extended Learning

Car Pick Up

CHOOSE YOUR CLASS (Student #1)

HIP-HOP DANCE 5TH-8TH (WED)$295

HIP-HOP DANCE K-4TH (TUE)$295

STUDENT #2 INFORMATION

Child's First Name #2

Child's Last Name #2

Grade

Teacher Name

Any Allergy's

Choose an option

Extended Learning

Car Pick Up

CHOOSE YOUR CLASS (Student #2)

HIP-HOP DANCE 5TH-8TH (WED)$295

HIP-HOP DANCE K-4TH (TUE)$295

STUDENT #3 INFORMATION

Child's First Name #3

Child's Last Name #3

Grade

Teacher Name

Any Allergy's

Choose an option

Extended Learning

Car Pick Up

CHOOSE YOUR CLASS (Student #3)

HIP-HOP DANCE 5TH-8TH (WED)$295

HIP-HOP DANCE K-4TH (TUE)$295

AUTHORIZED STUDENT PICK UP

1. Authorized Parent Pick-up Name

1. Authorized Parent Pick-up Contact #

2. Authorized Parent Pick-up Name

2. Authorized Parent Pick-up Contact #

3. Authorized Parent Pick-up Name

3. Authorized Parent Pick-up Contact #

INTERESTED AND WOULD LIKE MORE DETAILS?

ANY QUESTIONS

Any Questions or Comments?

WHARTON REGISTRATION

PARENT'S CONTACT INFORMATION

STUDENT'S INFORMATION

MEDIA RELEASE

Be prepared to present your I.D. and school assigned car tag # for verification at the time of pick up.

STUDENT #2 INFORMATION

STUDENT #3 INFORMATION

AUTHORIZED STUDENT PICK UP

INTERESTED AND WOULD LIKE MORE DETAILS?

ANY QUESTIONS