After School Program

Name *

First Name

Last Name

Phone

(###)

###

####

School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I would like Spanish Room for : *

Pk (Day Care) Students

KG Students

Elementary School Students

Middle school Students

Homeschool Co-op Students

Staff (Adults)

I would like the program for: *

Beginner Students

Students in the Dual Spanish Program

Both

Preference time *

7 am to 12 pm

1 pm to 4 pm

4 pm to 8 pm

Preferens days *

Monday / Wednesday

Tuesday / Thursday

Friday / Saturday morning

How would you like to communicate with the parents to catch interest in the Program? *

By email (you prepare your own advertise)

By email using our email template

By printed flyer (we provide printable pdf)

How would you like to implement the registration? *

We will do the registration and share the roster list with Spanish Room

We want Spanish Room to run the registration and share the Roster with us

How long do you want the session? *

6-week

8-week

10-week

The entire school year

Summer break (June and/or July)