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    Czech and Slovak School of Pittsburgh Student Enrollment Form - 2020/2021




    If more than one student from the family is attending, please fill here:





    My child may be released to the person(s) signing this agreement and/or to the following designated person(s). Please list name, Address and Relationship

    Persons to contact in case of emergency, when parents cannot be reached. Enter Name, Relationship, Home Phone number and Cell Phone number

    Medical information

    ​Does your child suffer from any allergies (food, beverages, medication, insect bites/stings)? 
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    ​List any illnesses, injuries, hospitalizations within last 12 months: 
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    ​List any medications your child is currently taking: 
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    ​Does your child have any medical condition we should be aware of? 
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    Does your child have any special needs or any behavior we should be aware of?​

    Provide any additional information that will help us get to know and understand your child. What language is primarily spoken at home (with mother/with father)? Are there any opportunities for your child to speak Czech/Slovak outside of the classroom (grandparents, friends, etc.)?  What language does your child prefer? Any other comments or information that you believe our teachers should know? What do you expect your child to gain from attending the school?

    ​Tuition and classes

    Tuition for each semester is $100, depending on your child's age. For detailed information about classes and payments, please visit our information page. 

    ​Consent for emergency medical assistance

    Click HERE to review the policy and initial: 

    ​Right to use images:

    Click HERE to review the policy and initial: 

    Sharing contact information
    ​

    Click HERE to review the policy and initial: 

    Nondiscriminatory policy

    Click HERE to review the policy and initial: 

    By writing my name to the box below, I agree with the Waiver of Liability (click HERE to review)and I acknowledge that I have read and understood this form in full for the purpose of registering my child/children at the Czech and Slovak School of Pittsburgh. I agree to abide by the rules and regulations of the Czech and Slovak School of Pittsburgh and that my child/children will do the same. 
    Please click the button bellow to submit your registration. 
    If any of the required fields are missing or any field is entered incorrectly, you need to correct the highlighted fields before a successful submission.
    A message will appear when your online application has been successfully submitted. 
Submit

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skola@czechslovakschoolpgh.org
Wightman School Community Building
5604 Solway Street
Pittsburgh, PA 15217-1264
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