| April Camp Registration
Form
Child's
Name:___________________________________________________
Age:____________ Grade:_____________________
DOB:________________
Class that you are registering for (morning or
afternoon):_________________________
Language registering
for:___________________________________________________
Previous instruction in a foreign language?
____________________________________
How much and
where?:____________________________________________________
Allergies:_______________________________________________________________
Please list names of individuals authorized to pick up your
child:
Name:_____________________Relationship:__________________________________
Name:_____________________Relationship:__________________________________
Photo release authorization:
Kim Andersen, Helene Roth, Capital Region Language Center
Instructors and/or local news organizations have my
permission to photograph my son/daughter during class time,
to be used for promotional purposes of the Capital Region
Language Center.
Signature:______________________________________________________________
Parent Contact Information
Name:__________________________________________________________________
Address: _______________________________________________________________
Phone Numbers: Which is the best way to reach you at
the last minute?___________
(H):______________________(C):___________________(W):____________________
Email:__________________________________________________________________
Method of payment:
_cash
_check
_credit card (MasterCard/Visa/Discover)
Please call with the following information:
CC number, expiration date, CV code, billing street address
and zip code
Release
I have read the course description and the information about
school policies.
Signature:_______________________________________________________________
Please print the registration
form and send or bring it with payment to Las Mariposas.
Please review the
school policies before registering for a class session.
If you have any questions
email or call us at 518 884-HOLA (4652).
|
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