Please print the registration form and send or bring it to:
     Capital Region Language Center
     2124A Route 50
     Ballston Spa, NY 12020

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).

Child's Name:___________________________________________________

Age:____________ Grade:_____________________ DOB:________________

Class day and time that you are registering for:________________________________

Language registering for:___________________________________________________

Previous instruction in a foreign language? ____________________________________

How much and where?:____________________________________________________

Allergies:_______________________________________________________________

For middle and high school students only (next 2 questions):

School & Teacher:________________________________________________________

Teacher's contact information:______________________________________________

Please list names of individuals authorized to pick up your child:
                     
Name:_____________________Relationship:__________________________________

Name:_____________________Relationship:__________________________________

Photo release authorization:
Kim Andersen and the 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:__________________________________________________________________

How did you hear about us? ________________________________________________

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:_______________________________________________________________