Email Address *

Home Address *

Email Address *

Registration Form

Electronic Signature *

What school does your child/children attend? *

Notes/Special Instructions

Medical Information *

Parent 1 Name & Cell Number *

Free PNO Coupon Code

How did you here about our program? *

The following Person(s) have/has permission to pick up my child/Children from Language International Kids *

Automatic Monthly Payments Here

Brain Juice Makers Space Camp

After payment is made, forward a copy of the receipt with your child's name for payment identification to: shirah.frazier@languageinternationalkids.com

Child/Children's Name *

(Located behind the Turner Monumental AME Church)

31 Saunders Street NE Atlanta, Ga 30317

"Giving Kids A Learning Experience Beyond the Classroom"

Choose T-Shirt Size(s) Youth-XSM, SM, MED, LRG,. Adult- SM, MED, LRG, XL *

Passport Explorer Camp

PAY FEES HERE

Parent's Night Out Fees

Choose Program(s) *

After School Program 2018-2019 Reader's Theater Chit Chat Math

Passport Explorer Camp

Brain Juice Maker's Camp

Parent's Night Out

Tutoring

*Day Camp(SNOW DAYS /School Closing Days*)

After payment is made, forward a copy of the receipt with your child's name for payment identification shirah.frazier@languageinternationalkids.com

Custom Payments Here

Program start date? *

Parent 2 Name & Cell Number *

Age & Grade *

I Hereby authorize Language International Kids Edu Service to seek emergency medical assistance for my child/children in the event the parent or guardian is not available. I will assume full responsibility for all charges related to the above. *

Yes, I give my permission

After School Program Fees (Reader's Theater & Chit Chat Math)

​"Giving Kids A Learning Experience Beyond the Classroom"

"Giving Kids A Learning Experience Beyond the Classroom"