The German School of Dallas

Registration Form

Adult Advanced 5-Week Summer Course

May 22 – June 19, 2021

Summer Adult Advanced Class	Saturdays 9:30 - 11:30 a.m.	☐	$130 + $20 Registration Fee = $150

Student Name:	Level of Proficiency
1 Student Name	Choose an item.
2 Student Name	Choose an item.

Contact Information
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TO REGISTER, please complete this fillable form and email it to: info@germanschooldallas.com

Photo Release Agreement:
I/We hereby permit the school to use photos or any other media format of me/us in school related papers such as brochures, the school website or in newsletters. (PLEASE CHECK ONE)
YES ☐ NO ☐
Are you a member of the German American Club?
YES ☐ NO ☐	I would like to receive more info about the German American Club and the tuition assistance they offer!	☐

To pay via Zelle, send payment to:	Send check to:
THE GERMAN SCHOOL OF DALLAS info@germanschooldallas.com (Please include the student’s name on memo line)	The German School of Dallas Post Office Box 793388 Dallas, TX 75379

Questions? Call Petra Terpak at 972-922-5161 or email me at info@GermanSchoolDallas.com

http://www.germanschooldallas.com

DISCLAIMER
By submitting this registration you agree to the following terms: I/We agree to assume all responsibility for compliance with the rules and regulations imposed by The German School of Dallas. I/We, being parent(s) or legal guardian(s) hereby acknowledge that The German School of Dallas is not responsible for any bodily injuries while the students attend class or on the church property. If a child presents a severe discipline problem, the teacher will discuss this with a responsible parent/guardian. If necessary, the school reserves the right to dismiss such a student. The Medical Treatment Authorization and Consent Agreement is designed for those situations where children and/or minors are unaccompanied by either parents or legal guardians. It gives authority to a designated adult to arrange for medical care for a child and/or minor in the event of an emergency. Medical care cannot be provided to a child and/or minor without approval by the parents or legal guardians, unless you are declaring your consent by submitting this form. I/We, being parent(s) or legal guardian(s) do hereby authorize a representative of The German School of Dallas or such substitute as he/she may designate as agent of the school to consent to any X-Ray, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the registered student named child and/or minor which is deemed advisable by and to be rendered under the general or special supervision of any physician and/or surgeon, licensed under the Provision of Medicine Practice Act or of any dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, or elsewhere.
I accept disclaimer
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