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Culture Club - 2019/20 School Year Enrollment Laurelhurst - Beginner French
Beginner French - Wednesdays 3:30-4:30, Starting September 18th, Minimum enrollment required
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Email
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Student Information
Has the child studied a second language before?
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Child's first name
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Child's last name
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Child's age
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Does child have any allergies or special needs?
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Please explain
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Parent Information
Mother's name
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Cell phone
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Email Address
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Mailing Address
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Languages spoken
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Father's name
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Email Address
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Cell phone
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Mailing Address (if different from mother)
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Languages spoken
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Emergency Contact
Emergency contact name
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Phone
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Relationship to child
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Alternative pick-up
Alternative pick - up name
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Phone
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Relationship to child
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Authorisation
Check the items below indicating authorisation
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My child may be photographed. Photos may be used for publicity purposes with no names attached.
My child may participate in field trips by foot.
I give the staff permission to obtain and authorize any necessary medical treatment for my child and understand my child may be transported to the nearest hospital by ambulance in the event of an emergency.
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I understand and commit to the following:
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I commit my child to the study of language for the whole school year.
I understand that refunds are not possible after the second class of the year, and that 30% of tuition will be retained to balance minimum enrollment
I understand that I will be billed an additional $35 for late payments more than 5 days late.
Required
Payment Options
Payment by Venmo @ Jamie-Michaud or check made out to Culture Club on first day of class
Payment choices (30 sessions)
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One lump sum of $700, due Sept 18th
Fall term $250, due Sept 18th
Other:
Would you like to contribute to a scholarship fund?
Yes, I would like to donate to the scholarship fund and will paypal a donation to
jamie.michaud@gmail.com
Other:
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Please make checks out to:
Culture Club
3145 NE Flanders St.
Portland, OR 97232
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