Fall 2022 Registration- CAC Online School Program

Student(s) Information

• First Student Full Name
• First Student Email (if any)
• First Student Grade in Fall 2022
• Has the first student learned Arabic before? (If yes, please indicate where and what level)
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• Second Student Full Name
• Second Student Email (if any)
• Second Student Grade in Fall 2022
• Has the second student learned Arabic before? (If yes, please indicate where and what level)
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• Name(s) in Arabic

First Parent Info (for minor students). Adult students, please fill your name, address and phone #)

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * Phone:

• Fee

  Type	Fee
  One student/ Fall Semester	$700.00
  One Student Full year (Fall and Spring)	$1,350.00
  Two students Fall Semester	$1,400.00
  Two students full year (Fall and Spring)	$2,700.00

Second Parent Information (If student is minor)

• First Name
• Last Name
• Email Address
• Address (if different from First Parent's Address)

Emergency Contact

• Full Name
• Phone Number

• Publication of Photographs and Films: For the sole purpose of promoting The Center for Arabic Culture (CAC) mission in the community, CAC would like to use photographs and films of its students in CAC events on its website and social media.

  • Yes, I give permission for my child photo or video to be used
  • No, I do not give permission for my child photo or video to be used

Student Information

You may add a maximum of 3