‘ANA TIL’ UYGHUR LANGUAGE COURSE

REGISTRATION FORM

Thank you for your interest in Ana Care and Education. Please provide the following information for course registration purposes. Please fill out the accompanying enrollment form and make a payment under the ‘Tuition’ Page. Your child(ren) will then be active students in the Sunday Uyghur Language Course for 3 months (12 classes, total of 36 Hours).

Field's marked with an asterisk (*) are required.

Child information

parent/guardian information

Can we use your cell phone number to add you to ACE's Whatsapp?

Emergency Contact Information

 

Please list two emergency contacts other than Parent(s)/Guardian(s) listed above. Emergency Contacts may be allowed to pick children up if a parent/guardian is unable to. Please notify ACE immediately if there is a change or addition to the Emergency Contacts.

Emergency Contact I

Medical Problems/Allergies

*Please note you are required to sign a Medical Release Form in person.*

Emergency Contact II

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Contact Us

Tel: (571) 354-0549

Email: admin@anacareeducation.com

Address

3607-A Chain Bridge rd
Fairfax, Virginia 22030