REGISTRATION 2023-2024 User Email * User Password * Student Last Name Student First Name School * Brent Hearst Lafayette Murch Camps Grade SY2023-2024 (Prek-3 must be potty trained) * Pre-K 3 Pre-K 4 K 1 2 3 4 5 Daytime Teacher Name 2023-2024 0 characters Does your child have any food allergies? *Yes No Does your child have allergies to other substances? *Yes No Does your child have any chronic physical problems? *Yes No Does your child require any special accomodations? *Yes No Does your child have any emotional/ behavioral needs? *Yes No Does your child have any learning disabilities? *Yes No Does your child have an IEP? *Yes No If you answer yes to any of the above, please explain. Please describe what the IEP entails. Otherwise leave it blank. Home Address * City, State and ZIP * Parent/ Guardian 1 First and Last Name * E-mail * Phone * Parent/ Guardian 2 First and Last Name E-mail Phone Emergency 1 First and Last Name (other than parents/guardians) * Emergency 1 Phone Number * Emergency 2 First and Last Name (other than parents/guardians) Emergency 2 Phone Number Authorized persons to pick up your child (other than parents/guardians/emergency). Please write first and last name of up to 3 people * --CLS Handbook *I have read and agree to Capitol Language Services terms and conditions. They can be viewed and downloaded from the Terms of Service Page. If you are registering for before and/or after-school, you are about to submit one payment online. The deposit allows you to be admitted in the program and will apply to the last month of tuition of your child, usually June the following year. Parents will be contacted and asked to fill out a payment authorization form in order to set up a recurring payment. The form is mandatory to complete the enrollment. Enrollment and recurring payment can be canceled with a 30-day notice. For the purpose of simplification, CLS only offers this payment option. * I understand that I will have to fill out an authorization form to set up a payment N/A - Camps I would like to register a second child Yes No Student Last Name Student First Name Grade Daytime Teacher Name - leave it blank if unknown 0 characters Does your child have any food allergies?Yes No Does your child have allergies to other substances?Yes No Does your child have any chronic physical problems?Yes No Does your child require any special accomodations?Yes No Does your child have any emotional/ behavioral needs?Yes No Does your child have any learning disabilities?Yes No Does your child have an IEP?Yes No If you are registering your second child and you answer yes to any of the above, please explain. Please describe what the IEP entails. Otherwise leave it blank. 0 characters I would like to register a third child Yes No Student Last Name Student First Name Grade Daytime Teacher Name - leave it blank if unknown 0 characters Does your child have any food allergies?Yes No Does your child have allergies to other substances?Yes No Does your child have any chronic physical problems?Yes No Does your child require any special accomodations?Yes No Does your child have any emotional/ behavioral needs?Yes No Does your child have any learning disabilities?Yes No Does your child have an IEP?Yes No If you re registering your third child and you answer yes to any of the above, please explain. Please describe what the IEP entails. Otherwise leave it blank. 0 characters Submit
