German Heritage Language School Association of Nova Scotia
Registration for Children




     German Heritage Language School
     5873 Inglis Street
     Halifax, NS  B3H 1K7



     Term :   ________________________________

     Level :   Beginner        Intermediate     Advanced

     Fee  :    ________________________________


     Name                                                               Date of Birth             Age

     1. _________________________________   _______________   _____

     2. _________________________________   _______________   _____

     3. _________________________________   _______________   _____

     4. _________________________________   _______________   _____


     Parent/Guardian :     ____________________________________________________

     Address : _____________________________________________________________

     City :        ___________________________________    Postal code :  ____________

     Phone :    home  ___________________________    work   _____________________

     Email :     _____________________________________________________________

     Waiver :  I/We, the parent(s)/guardian(s) of the above student(s), expressly release the
                   German Heritage Language School Association of NS, its Board of Directors
                   and its teachers from any and all liability arising from or incidental to the
                   student's participation in any of the events, programs or activities of the
                   German Heritage Language School.




     Date :   _______________               Signature :   _____________________________