enrollment | registration form
Please either:
a) Print out this web page or
b) Click here to download the form (pdf format) and print out
Fill out either form and fax to: 808.356.0949
ENROLLMENT FORM
To register for a class, please fill out the attached form and email, fax or mail to us at:
LITTLE AMBASSADORS
725 Kapiolani Blvd., Suite C106
Honolulu, HI 96813
littleambassadors@gmail.com
Fax: 808.356.0949
We will confirm that we have received your registration and will notify you about the availability of the class(es) you selected. Please mail or bring payment to the first class (checks payable to Little Ambassadors). Tuition is non-refundable after the first week of class.
Child 1:
First Name:__________________MI:______Last Name:_______________M F(Circle)
School______________________________Grade___Age____DOB___/___/_________
*Allergies (food/medical) or special medical problems:
Write none, if none known _____________________________________________________________________
Child2:
First Name:__________________MI:______Last Name:_______________M F(Circle)
School______________________________Grade___Age____DOB___/___/_________
*Allergies (food/medical) or special medical problems:
Write none, if none known__________________________________________________________________
Doctor____________________________________Phone_________________________
Mother's Name_______________________ Father's Name_________________________
Email _______________________________ Email ______________________________
Employer_____________________________Employer___________________________
Work Phone__________________________ Work Phone_________________________
Home Phone__________________________ Home Phone_________________________
Cell/Other____________________________ Cell/Other___________________________
Billing Address__________________________________
City ______________________State ____Zip_________
How do you prefer to be contacted? Email, cell, home phone, work phone (Circle)
EMERGENCY CONTACTS: (Other than parents, also authorized to pick up my child.)
*Name___________________________________________Phone__________________
*Name___________________________________________Phone__________________
*Name___________________________________________Phone__________________
Child 1:
Language: Chinese Japanese Spanish(Circle one)
Option 1: Day:________Time:_________ Option 2: Day:__________Time:_________
Child 2:
Language: Chinese Japanese Spanish(Circle one)
Option 1: Day:________Time:_________ Option 2: Day:__________Time:_________
How did you hear about us? (Circle all that apply)
* Word of mouth * Email * Hawaii Parent * Island Family
* Star Bulletin * Advertiser * MidWeek *Google or Yahoo search
* Other ________________________________________________
Has your child been exposed to other languages? To what degree?
Child 1:____________________________________
Child 2:____________________________________
My child may be in Little Ambassador publicity photographs without his/her name. Y N (Circle one)
Parent/Guardian initials__________
I understand that if I pick up my child more than 5 minutes after the end of his/her class, I will be charged a late pick up fee in 15 minute increments at the rate of $10 until pick up.
a) Print out this web page or
b) Click here to download the form (pdf format) and print out
Fill out either form and fax to: 808.356.0949
ENROLLMENT FORM
To register for a class, please fill out the attached form and email, fax or mail to us at:
LITTLE AMBASSADORS
725 Kapiolani Blvd., Suite C106
Honolulu, HI 96813
littleambassadors@gmail.com
Fax: 808.356.0949
We will confirm that we have received your registration and will notify you about the availability of the class(es) you selected. Please mail or bring payment to the first class (checks payable to Little Ambassadors). Tuition is non-refundable after the first week of class.
Child 1:
First Name:__________________MI:______Last Name:_______________M F(Circle)
School______________________________Grade___Age____DOB___/___/_________
*Allergies (food/medical) or special medical problems:
Write none, if none known _____________________________________________________________________
Child2:
First Name:__________________MI:______Last Name:_______________M F(Circle)
School______________________________Grade___Age____DOB___/___/_________
*Allergies (food/medical) or special medical problems:
Write none, if none known__________________________________________________________________
Doctor____________________________________Phone_________________________
Mother's Name_______________________ Father's Name_________________________
Email _______________________________ Email ______________________________
Employer_____________________________Employer___________________________
Work Phone__________________________ Work Phone_________________________
Home Phone__________________________ Home Phone_________________________
Cell/Other____________________________ Cell/Other___________________________
Billing Address__________________________________
City ______________________State ____Zip_________
How do you prefer to be contacted? Email, cell, home phone, work phone (Circle)
EMERGENCY CONTACTS: (Other than parents, also authorized to pick up my child.)
*Name___________________________________________Phone__________________
*Name___________________________________________Phone__________________
*Name___________________________________________Phone__________________
Child 1:
Language: Chinese Japanese Spanish(Circle one)
Option 1: Day:________Time:_________ Option 2: Day:__________Time:_________
Child 2:
Language: Chinese Japanese Spanish(Circle one)
Option 1: Day:________Time:_________ Option 2: Day:__________Time:_________
How did you hear about us? (Circle all that apply)
* Word of mouth * Email * Hawaii Parent * Island Family
* Star Bulletin * Advertiser * MidWeek *Google or Yahoo search
* Other ________________________________________________
Has your child been exposed to other languages? To what degree?
Child 1:____________________________________
Child 2:____________________________________
My child may be in Little Ambassador publicity photographs without his/her name. Y N (Circle one)
Parent/Guardian initials__________
I understand that if I pick up my child more than 5 minutes after the end of his/her class, I will be charged a late pick up fee in 15 minute increments at the rate of $10 until pick up.
