Name & Last Name of Student
Phone
Cell Phone
Email
Language of Interest
Date to begin Course
Days:
Monday & Wednesday Tuesday & Thursday Saturday
Others:
 
Time:
5:30pm a 7pm 7pm a 8:30pm 9am a 12:15pm
Others:
 
Location:
San Patricio Caguas
 
Course:
Individual Pareja Group
 
Re-Enrollement
Yes No
If you answered Yes, please to fill the following field.
Date of last course :
 
Have you been evaluated during this year with PALI?
Yes No
Are you a participant of PALI KIDS? ( 6-17yrs)?
Yes No
If you answered Yes, please to fill the following fields.
Name of Parent:
Age of Student:
¿Who is Responsable for the Payment ?
Company Yourself Parent or Legal Guardian Others
 

This request does not complete its process of enrollment. The student must be present at the signing of the admission or payment plan form, as stated on the students regulations and policies. Seats will not be guarateed until all the enrollement process is completed.