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Albir Weekend School e-Registration
Albir Educational Center
4870 Old Tampa Hwy, Kissimmee, Fl, 34758
Contact: Sr. Ilham Bouharoual, (407) 729-0300, ilhmebouharoual@aol.com
Email address *
Student's name: *
Your answer
Student's gender *
Student's age:
Your answer
Student's grade at regular school: *
Your answer
Student's hobbies:
Your answer
Does your child take any medication or need any special assistance? *
Parent/Guardian (name):
Your answer
Parent/Guardian (phone number):
Your answer
Emergency contact (Name) *
Your answer
Emergency contact (Phone number) *
Your answer
Waiver and Release of Liability:
Check one of the boxes bellow to state your agreement/disagreement to the Waiver and then sign ONLY if you are the parent/guardian of the student.
Attendance/Pick-up/Drop-off at Albir Educational Center (Albir, herein) is the full responsibility of the parent/guardian and does not constitute any liability for Albir. As the parent/guardian, I acknowledge that I will NOT seek Albir held liable if any accident, injury, loss of property or any other circumstance or incident occurs during or because of my son’s/daughter’s participation in Albir activities. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from my son’s/daughter’s participation in Albir events. I hereby release and agree to hold harmless Albir, its officials, agents and employees, from any claims arising out of my son’s/daughter’s participation in those event(s). I have read, understand and accept all the statements recited above, and accept full responsibility as described. *
Parent/Guardian name signing to the above wavier
Your answer
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