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Maria Nilsson-Whitaker, dba POCOLOCO Spanish Programs
9600 Peralta Rd NEAlbuquerque, NM 87109Teléfono: (505) 797-8980Correo Electrónico:pocoloco@q.com Pagina Web:www.pocolocospanish.com
Documento de Matriculación/
Registration Form
Favor de completar, firmar y mandar a Maria en la dirección de arriba/
Please complete,sign and send to Maria at the address listed above
Nombre de niño(a)/
Child’s Name: ___________________________________________
Edad/
Age: ______
Grado Escolar/
Grade: ______
Escuela/
School: ______________
Fecha de Nacimiento/
Date of Birth: ______________________
Dirección de Hogar/
Home Address: _________________________________________
Código Postal/
Zip Code: _________________
Teléfono a Casa/
Home Phone: ______________;
Celular/
Cell Phone: _______________
Correo Electrónico/
E-
mail: _______________________________________________
Contacto de Emergencia/
Emergency Contact: _________________________________
Teléfono de Contacto de Emergencia/
Emergency
Contact Phone: __________________
Favor de marcar con sus iniciales/
Please Initial:
____ I understand that neither POCOLOCO Spanish Programs
nor the staff at the class- hosting facilit
y can be responsible for my child after 3:
00 pm when Spanish class is over.
____ I understand that the monthly tuition is due at the beginning of each month and should be sent directly to POCOLOCO’s
postal mailing address. I will not send payments directly to the teacher via my child.
(OVER
)
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