REQUIRED FIELDS*
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FATHER'S FIRST NAME*
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FATHER'S LAST NAME*
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MOTHER'S FIRST NAME*
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MOTHER'S LAST NAME*
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EMAIL*
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STREET ADDRESS*
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CITY*
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STATE*
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ZIP*
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COUNTRY*
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HOME PHONE*
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Work Phone
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Fax
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NATIONALITY*
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Will a parent be attending the adult immersion classes on the same weeks as the child?*
Yes No
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Parent's Occupation
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Emergency Contact Name & Phone Number
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How did you hear about us?
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CHILD INFORMATION
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Child 1
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Name
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Child 1 Age and Date of Birth
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Sex
Female Male
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ESTIMATED LANGUAGE LEVEL*
Beginning Intermediate Advanced
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Special Interest
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Child 2
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Name
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Child 2 Age and Date of Birth
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Sex
Female Male
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ESTIMATED LANGUAGE LEVEL*
Beginning Intermediate Advanced
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Special Interest
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Child 3
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Name
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Child 2 Age and Date of Birth
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Sex
Female Male
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ESTIMATED LANGUAGE LEVEL*
Beginning Intermediate Advanced
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Special Interest
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PROGRAM INFORMATION---Camp Catalina Children’s Programs
(Note: Camp sessions begin on Mondays and end on Fridays.)
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Course Start Date
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Course End Date
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Number of weeks of study
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Reason for choosing school:
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| Expectations: |
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| Please type the numbers and letters:
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