WHCS. Washington Heights Choir School Escuela de Coro de Washington Heights. an after school program un programa después de la escuela
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1 WHCS Washington Heights Choir School Escuela de Coro de Washington Heights an after school program un programa después de la escuela APPLICATION FORM FORMULARIO DE INSCRIPCIÓN Please print neatly and complete all sections. Favor de escribir en letra de molde y complete todas las secciones. Student s Name: Nombre del Estudiante Address: Dirección City/State/Zip: Ciudad/Estado/Zona Postal Parent(s) or Guardian: Padre(s) o Guardian Primary Phone: ( ) - - Cell/Work Phone: ( ) - - Teléfono Principal Numero Celular/Trabajo Parent s Address: Correo Electrónico de Padre(s) Page 1 of 5
2 TEXT MESSAGE ALERT AUTHORIZATION (not required no es requerido) Autorización de Mensajes de Texto I authorize the WHCS Program to send me text message alerts (SMS) to the following designated mobile phone number(s). Please note: depending on your mobile plan, you may be charged by your carrier (ex. AT&T, Verizon, etc.) for any text messages you receive. WHCS is NOT responsible for these charges. Messages will be sent from (347) Autorizo al Programa ECWH a mandar mensajes de texto al siguiente número. Favor note: que dependiendo de su plan telefónico, podría ser cobrado por recibir mensajes. El Programa ECWH no se hace responsable por estos cargos. Mensajes se mandaran desde el siguiente número. Mobile Phone #: ( )- - Celular: Alternate Mobile Phone #: ( ) - - Celular Alternativo: EMERGENCY CONTACT INFORMATION - INFORMACIÓN DE CONTACTO DE EMERGENCIA (List THREE emergency contacts other than parent/guardian information listed above.) (Favor de escribir TRES contactos en caso de emergencia que no sea el padre o guardian) 1. Contact Contacto 2. Contact/Contacto Page 2 of 5
3 3. Contact - Contacto Nombre Complete PERSONAL INFORMATION ABOUT STUDENT: INFORMACIÓN PERSONAL DEL ESTUDIANTE Date of Birth: / / Grade: School: Fecha de Nacimiento Nivel escolar Escuela: Do you currently study art, dance or music in school? Estudia Baile, Pintura, o Música en la escuela? If so, what classes/programs are you involved in? Si, la respuesta es si a la pregunta anterior, escriba las actividades. Please list any allergies (including food allergies) or other important medical information we should know (including medications currently taken by student): Por favor escriba alergias que si hijo tenga (incluyendo de comida) al igual que otra información (ej. medicina que su hijo/a este tomando) importante que debemos saber de su hijo/a. Page 3 of 5
4 TRANSPORTATION TRANSPORTACIÓN (Students MUST be picked up by adults only. Adults MUST present a government issued photo ID to pick up student.) (Solo un adulto puede recoger al estudiante y debe presentar una identificación oficial con fotografía) Pick-Up Contact #1 Contacto que recogerá a su hijo/a Pick-Up Contact #2 Contacto que recogerá a su hijo/a Nombre Completo: Pick-Up Contact #3: Contacto que recogerá a su hijo/a Nombre Completo: Page 4 of 5
5 In the event of an emergency illness/accident, we will transport (or call an ambulance) the student to the nearest medical facility to be treated. We will contact parent/guardian first; if we receive no answer, we will contact the emergency contacts listed above. En caso de emergencia/accidente, llevaremos a su hijo/a al centro medico mas cercano. Contactaremos al padre/guardián primero, pero en dado caso que no tengamos respuesta, llamaremos a las personas mencionadas en Contactos de Emergencia. By submitting this registration form, you agree to all terms listed in the WHCS policy manual, as well as to any information contained in this form or any other documents provided to you by the WHCS program. Al entregar este formulario, usted acepta todas las reglas del programa ECWH, así como la información contenida en este formulario o cualquier otro documento que le ha proporcionado al programa. Parent/Guardian (please print): Date: / / Padre/Guardian (letra de molde) Fecha: Parent/Guardian Signature: Firma del Padre/Guardian Page 5 of 5
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