Culture Club - 2019/20 School Year Enrollment Abernethy

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Culture Club - 2019/20 School Year Enrollment Abernethy - Beginner French

Beginner French - Tuesdays 3:00-4:00, Starting September 17th

Email *

Student Information

Has the child studied a second language before? *

yes

Child's first name *

Child's last name *

Child's age *

Does child have any allergies or special needs? *

yes

Required

Please give details

Please explain *

Parent Information

Mother's name *

Cell phone *

Email Address *

Mailing Address *

Languages spoken *

Father's name *

Email Address *

Cell phone *

Mailing Address (if different from mother) *

Languages spoken *

Emergency Contact

Emergency contact name *

Phone *

Relationship to child *

Alternative pick-up

Alternative pick - up name *

Phone *

Relationship to child *

Class information

Classes will be held on Tuesdays days from 3:05 until 4:05 in room # 3
Classes will begin on September 17th. Minimum enrollment required

Authorisation

Check the items below indicating authorisation *

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.

Required

Commitment to a full school year of study

I understand and commit to the following: *

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 choices (30 sessions) *

Early enrollment discount $675 {MUST ENROLL BY 7/10} Must send non refundable $100 deposit via paypal to jamie.michaud@gmail.com - Remainder of $575 is due by Sept 16th

One lump sum of $715, due Sept 16th

3 term payments: fall $415 - due Sept. 16th, winter $215 - Nov. 26th, spring $115 due March 15th

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:

Clear selection

Please make checks out to:

Culture Club
3145 NE Flanders St.
Portland, OR 97232

Other

How did you hear about us? *

Send me a copy of my responses.