ELP KIDS
Child's First Name
*
Preferred Name
Last Name
What is your child's first language?
How fluent is your child in their first language?
My child can speak fluently their first language.
My child can write fluently in their first language.
My child can speak and write in their first language.
My child is not comfortable in their first language.
Do you speak any other languages at home?
What is your child's level of English? (This helps us in creating our lesson material)
Understands little to no English
Can recognize and mimic basic words and phrases
Can understand phrases and sentences and is expanding their vocabulary.
Can communicate clearly in English
Can your child write in English?
Yes
Somewhat
A little
No
Date of Birth
School Grade
-- None --
Nursery/Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Parent/Guardian 1
Phone Number
Email Address
Parent/Guardian 2
Parent/Guardian 2 Phone
Parent/Guardian 2 Email
Home Address
Home Address Line 2
Home Postal Code
Home City
Home Province
Emergency Contact 1 Please Provide Name, Phone Number and Relationship to Child
Emergency Contact 2 Please provide Name, Phone Number and Relationship to Child
Medical Information - Please indicate if there are any allegies or medical conditions regarding your child
Parent Permission - I consent that pictures can be taken of my child and be used on the social media platforms on Converge Community Church
Yes
No
Parent Signature
I confirm my permission for my child to attend this programming.
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