Registration for Kids Spanish Classes

We accept Checks & Money-Orders. Contact LACI about Credit Card processing.

To Register your Child for: Boulder Spanish Summer Camp , please complete the following application below; Items indicated with an Asterisk (*) are required.
Please Click  "REGISTER NOW!"  ONCE.

STUDENT INFORMATION

* Student's Name: First    Last 

* Birth Date: [MM/DD/YYYY]      * Gender: Male     Female

PARENT INFORMATION

* Parent's Name: First    Last 

* Address: Street+Apt#   City   State   Zip 

* Phone: 720-555-1212  Best contact phone number, Please.  * Email: 

GUARDIAN INFORMATION

* Guardian's Name: First    Last 

* Address: Street+Apt#   City   State   Zip 

* Phone: 720-555-1212  Best contact phone number, Please.  * Email: 

ALTERNATIVE EMERGENCY CONTACTS

* Name: First    Last     * Phone: 720-555-1212  Best contact phone number, Please.

* Name: First    Last     * Phone: 720-555-1212  Best contact phone number, Please.

MEDICAL INFORMATION

* Hospital/Clinic:    * Doctor's Name: First    Last 

* Phone: 720-555-1212  Direct line or Office

* Insurance Company:    * Policy Number:

* Allergies – Special Health Considerations:  

* I authorize all medical and surgical treatment, 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 and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.
 YES     NO

If you do not feel comfortable filling out the on-line form, you can print out the PDF version and deliver it to LACI.

CHOOSE A CLASS

Kids Courses in Boulder:

Kids Courses in Denver:

*  Please describe when, if ever, you have taken Spanish classes and what level of Spanish you were taking.

    

*  Why do you want to learn Spanish?

    

*  How did you hear about LACI?

    

  


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