Registration FALL 2019
Email address *
Student Name *
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Student Age *
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Student's Birth Date
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Parent 1/Legal Guardian`s Name *
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Parent 1/Legal Guardian`s phone number *
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Parent 1/Legal Guardian`s E-mail *
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Parent 1/Legal Guardian`s Address *
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Parent 2/Legal Guardian`s Name
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Parent 2/Legal Guardian`s phone number
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Parent 2/Legal Guardian`s E-mail
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Parent 2/Legal Guardian`s Address
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Emergency contact-Name *
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Emergency contact-phone number *
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I am a new student. I have never attended MRS classes previously. *
Please proceed to classes selection. Keep in mind that Art and Theater classes have an additional charge, already included in the tuition for supplies. Annual registration fee is $35 for each student. *Please note, when a student is signed for a single class the tuition is higher than if a student is registered for two or more classes. Please contact out financial director with questions or find more info on our website. *
Required
Please list any student allergies or health concerns that you would like the school to be aware of *
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I have read and understood all school policies. Please read our policies here: https://www.madisonrussianschool.org/for-parents *
I agree to pay fully before September 15th.Payment plans are available upon request. Please contact out financial director for more info. *
I HEREBY AUTHORIZE MY SON / DAUGHTER TO ATTEND CLASSES IN MADISON RUSSIAN SCHOOL . I UNDERSTAND THAT EVERY STUDENT MUST BE INSURED FOR MEDICAL EXPENSES ARISING FROM ACCIDENTAL INJURY THROUGHOUT A POLICY WHICH HIS / HER FAMILY CURRENTLY HAS IN FORCE AND WHICH WILL COVER HIS/HER PARTICIPATION IN THIS PROGRAM. WITH THIS AUTHORIZATION, I HEREBY RELEASE MADISON RUSSIAN SCHOOL, INC., ITS TEACHERS AND EMPLOYERS FROM ANY LIABILITY INCURRED IN THE CONDUCT OF THIS PROGRAM. THIS AUTHORIZATION WILL REMAIN IN EFFECT UNLESS TERMINATED BY PARENT OR GUARDIAN IN WRITING. *
I authorize the use of my child's image (photo or video) to be used on the school's website, other sites, photo albums, or any other media. *
By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
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