2024/2025 Registration – Mladý Sokolík 2024/2025 Registration Form – Mladý Sokolík Please complete this form to register to the School and do not hesitate to contact us with any questions. Step 1 of 7 14% Family Contact Details1st Parent/Guardian Name* First Last 1st Parent/Guardian E-mail* 1st Parent/Guardian Phone Number*2nd Parent/Guardian Name First Last 2nd Parent/Guardian E-mail 2nd Parent/Guardian Phone NumberHome Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Number of Children being signed up:*Please indicate the number of children you will be registering. Please enter “0” if none are being registered. If there are more than 3 children being registered, please do 3 now, and up to 3 again afterwards. The form can only register up to 3 children at a time. Please enter a number from 0 to 4. First Child Details1st Child's Name* First Last 1st Child's Age*1st Child's Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201st Child's Place of Birth1st Child's Citizenship1st Child's Grade1st Child's Main Languages Spoken at Home (Please indicate level of Fluency)*1st Child's Known Allergies/medical conditions (Please be as detailed as possible):*1st Child's reduced mobility – injuries etc. (Please be as detailed as possible):*1st Child's Limb dominance:* Second Child Details2nd Child's Name* First Last 2nd Child's Age*2nd Child's Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119202nd Child's Place of Birth2nd Child's Citizenship2nd Child's Grade2nd Child's Main Languages Spoken at Home (Please indicate level of Fluency)*2nd Child's Known Allergies/medical conditions (Please be as detailed as possible):*2nd Child's reduced mobility – injuries etc. (Please be as detailed as possible):*2nd Child's Limb dominance:* Third Child Details3rd Child's Name* First Last 3rd Child's Age*3rd Child's Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119203rd Child's Place of Birth3rd Child's Citizenship3rd Child's Grade3rd Child's Main Languages Spoken at Home (Please indicate level of Fluency)*3rd Child's Known Allergies/medical conditions (Please be as detailed as possible):*3rd Child's reduced mobility – injuries etc. (Please be as detailed as possible):*3rd Child's Limb dominance:* Emergency Contact DetailsEmergency Contact Name* First Last Emergency Contact Phone Number*Relation to Child*Authorized to pick up?*YesNoEmergency Agreement* I authorize the school to contact the physician or an ambulance if I cannot be contacted during an emergency School Approvals2023-2024 FilePlease Download this fileI read and agree with the document named "Školní řád" = School Rules (full file above).*I read and agree with the document named “Školní řád” = School Rules (full file above). I agreeSchool Activities Location*I agree that my child may participate in school activities located outside the regular classroom. I agreeMedia ReleaseI agree with capturing photos and videos during camp/school activities. They are created to document students’ achievements and promote our school. Photos and videos are used in various media. I agreeGeneral Consent* The personal information is collected for the school registration under the Alberta’s Freedom of Information and Protection of Privacy Act (FOIP) and the Canadian Charter of Rights and Freedoms, Section 23. This information is used to establish a student record, to provide a safe and secure school including class placement, and to access contact and health information in case of problems or emergencies. I, the undersigned, hereby represent that I have the legal authority to register the child. I declare the information that I have provided on this form is complete and accurate. I will notify the school of any information changes on this form.Please read the following form:*https://calgaryczechschool.ca/wp-content/uploads/2025/01/CCA-Extracurricular-Recreation-Athletic.pdf Thank you! I agree to sign the given form at the first lesson Payment DetailsSchool Fees:*• Fees include instruction, textbooks and supplies • One free trial is available I understandMladý Sokolík Quantity Price: $ 150.00 CAD Quantity physical activities: 10 lessons Total $ 0.00 CAD Payment Options*Please choose an option to confirm how you will pay for your selection E-Transfer to [email protected] Cash E-Transfer* Please send an e-transfer from your bank to [email protected] The security question should be “What is this for?” The answer should be “sokolík” Thank you! I have sent the E-TransferOther* Please send an email explaining how you would like to pay to [email protected] Thank you! I have sent the EmailYour Signature*By signing this document you agree to have the payments for this registration delivered within 5 days of the form’s submission. You are also certifying that all the information provided is true and accurate for all the members involved.CAPTCHANameThis field is for validation purposes and should be left unchanged.
