EmailMe Form - Registration - Virtual Programs

STUDENT INFORMATION

Please complete a separate form for each child

Student's Full Name (First and Last) *

Age

Birthday *

MM / DD / YYYY

Grade in 2016-2017

PROGRAMS REQUESTED

Please selected classes for this child only

Russian (in Russian)

Russian 01 (ages 3-8), 10 weeks, starting September 14

Russian 02 (ages 5-9) TBA TBA

Russian 03 (ages 6+) 10 weeks, starting September 28

Russian G1 (ages 7+) 10 weeks, starting September 14

Russian G2 (ages 8+) 10 weeks, starting September 14

Russian G3 (ages 9+) 10 weeks, starting September 14

Math+Logic, Informatika (in Russian)

Infromatika 1 (grades 3+), 5 weeks starting September 14

Math+Logic 1 (grade 1), 10 weeks starting September 21

Math+Logic 2 (grade 2), 10 weeks starting September 21

Business Game (in Russian/English)

Level 1 (grades 3+), 5 weeks starting September 14

Level 2 (grades 4+ completed Level 1), 5 weeks starting September 14

History of Russia (in Russian)

History of Russia 1 (grades 3+), 5 weeks starting September 28

PARENT INFORMATION

Full Name (first parent or legal guardian) *

Full Name (second parent or legal guardian)

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Work Phone

### - ### - ####

Cell Phone 1 *

### - ### - ####

Cell Phone 2

### - ### - ####

Email 1 *

Email 2

Additional contact information in case of emergency (phone #, name, relation)

Whom can we thank for recommending us?

CHILD EVALUATION AND GOALS FOR ATTENDING OUR PROGRAMS

This information is required for new students registering for Russian, Math, Art. Optional for returning students and new students registering for Music and Theater classes.

RUSSIAN

Alphabet

doesn't know alphabet

knows some letters

knows all letters

Reading

doesn't read

reads by letters

reads by syllables

reads by whole words

Writing

doesn't write

write's in print letters

write's in script

Speaking

doesn't speak

speaks slow

speaks fast

mixes Russian and English words

At home we speak

Russian

English

both

What would you like for your child to achieve as a result of attending our Russian program?

Any other comments?

*

I Agree