2019-2020 Arabic Language Program Registration
RequiredRequired Question(s)
THE FOLLOWING SURVEY IS YOUR REGISTRATION FOR ALP CLASSES AT OUR LADY OF THE CEDARS FOR THE 2019-2020 SCHOOL YEAR

ANNUAL FEES ARE AS FOLLOW:

ONE CHILD: $100 TWO CHILDREN$175 THREE OR MORE CHILDREN: $250

CLASSES ARE FROM 9:00-10:15 The first day of CCE is September 21st
 
Required 1.
PLEASE ENTER THE PARENT/GUARDIAN'S INFORMATION BELOW

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
2ndemail:
Spouse Full Name:

Required 2.

EMERGENCY CONTACT NAME (other than parent)

 

50 characters left.
Required 3.

EMERGENCY CONTACT RELATIONSHIP TO STUDENT

 

50 characters left.
Required 4.

EMERGENCY CONTACT PHONE 

 

50 characters left.
Required 5.

STUDENT 1 FULL NAME

 

50 characters left.
Required 6.
STUDENT 1 SEX
MALE
FEMALE
Required 7.

STUDENT 1 AGE

 

50 characters left.
Required 8.
STUDENT 1 Arabic Proficiency 
SPEAK
READ
WRITE
  • Comment:

  • 500 characters left.
Required 9.
DOES STUDENT 1 HAVE ANY OF THE FOLLOWING?
IF SO, PLEASE SPECIFY
SPECIAL NEEDS
DISABILITY
ALLERGIES
NONE
  • Comment:

  • 500 characters left.
10.

STUDENT 2 FULL NAME

 

50 characters left.
11.
STUDENT 2 SEX
MALE
FEMALE
12.

STUDENT 2 AGE

 

50 characters left.
13.
Student 2 Arabic Proficiency
SPEAK
READ
WRITE
  • Comment:

  • 500 characters left.
14.
DOES STUDENT 2 HAVE ANY OF THE FOLLOWING?
IF SO, PLEASE SPECIFY.
SPECIAL NEEDS
DISABILITIES
ALLERGIES
NONE
  • Comment:

  • 500 characters left.
15.

STUDENT 3 FULL NAME

 

50 characters left.
16.

STUDENT 3 SEX

MALE
FEMALE
17.

STUDENT 3 SEX

MALE
FEMALE
18.

STUDENT 3 Age

 

50 characters left.
19.
STUDENT 3 Arabic Proficiency
SPEAK
READ
WRITE
  • Comment:

  • 500 characters left.
20.

DOES STUDENT 3 HAVE ANY OF THE FOLLOWING?

IF SO, PLEASE SPECIFY.

SPECIAL NEEDS
DISABILITY
ALLERGIES
NONE
  • Comment:

  • 500 characters left.
Required 21.

Do you, the parent/guardian, of the students listed above, release from any liability The Eparchy of Our Lady of Lebanon, Our Lady of the Cedars Maronite Catholic Church, the priests, staff, teachers and all volunteers, including the medical volunteers?

YES
NO
Required 22.

Do you understand, and agree, that you will be responsible for any medical treatment that may be necessary for your child while on Church Property or while participating in off-site parish sponsored activities?

YES
NO
Required 23.

Do you authorize the priests, parish staff, and volunteers to administer any first aid and medical treatment that may be necessary in case of an emergency until you can be contacted?

YES
NO
The following question is your acknowledgement that you have personally filled out all the information above to the best of your knowledge.  By typing in your full name you are allowing it to serve as an electronic signature and agreement to questions 32-34.
 
Required 24.

DO YOU AGREE TO ALL THE TERMS AND CONDITIONS STATED ABOVE? IF YOU AGREE, CHECK YES AND FILL OUT YOUR FULL NAME IN LIEU OF A SIGNATURE.

YES
NO
  • Comment:

  • 500 characters left.