Registration for Enrichment with Immersion Island
Please fill out completely and submit. You will receive a confirmation email and invoice within a day or two! Gracias!

Student's first name *
Your answer
Student's last name(s) *
Your answer
Name used or nickname *
Your answer
Gender *
Grade in School *
Your answer
Current Age *
Your answer
Sibling(s) who will also attend this club *
Please still complete separate registration for each.
Your answer
Address *
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City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email address *
Your answer
Parent/Guardian Telephone # *
Your answer
Emergency contact name (other than above), relationship and phone # *
Your answer
Person(s) other than parent/guardian permitted to pick up student *
Your answer
Please note any other information you think we should know pertinent to this class/camp.
(Food allergies/ restrictions, activity limitations, special educational needs, etc.)
Your answer
Previous Spanish experience *
Let us know how much classroom or other Spanish experience student has had.
Your answer
Check all that apply *
Grades 2-5
Required
I will pay by the following method *
(You will receive an invoice by email)
Signature or Guardian - Please print name *
By signing here I agree to the terms on the Enrichment page on Immersionisland.org
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