Registration Form 

Thanks for your interest in Rose City Learning Center!
We’ve received your form and will be in touch soon with next steps.

We look forward to connecting with you!

Mèsi pou enterè ou nan Rose City Learning Center!
Nou resevwa fòm ou a epi n ap kontakte ou byento ak pwochen etap yo.

N ap pale avè w byento!

¡Gracias por su interés en Rose City Learning Center!
Hemos recibido su formulario y nos comunicaremos pronto con los próximos pasos.

¡Esperamos comunicarnos pronto!

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Email *
First Name/ nombre de pila/ premye non/
名 *
Last Name/ apellido/ siyati/ 姓 *
Phone Number/ número de teléfono/ nimewo telefòn/
电话号码 *
What town do you live in? /  ¿En qué ciudad vives? / Nan ki vil ou rete? / 你住在哪个城镇？ *
Birth Year/  año de nacimiento / ane nesans /
出生年份 *
Home Country/  país de origen/ peyi lakay/
祖国 *
Language(s) spoken *
Required
Year arrived in U.S./  año llegó a EE.UU./ ane te rive nan peyi Etazini/ 抵达美国年份 *
Preference in Class Time/  preferencia de horario de clase/
preferans nan tan klas la/
上课时间偏好 *
Higest Level of Education/ 
nivel más alto de educación/ pi wo nivo edikasyon/
最高教育水平 *
What kind of work have you done in the past/present? *
Are you employed? *
Who should we call if there is an emergency at school? List Name, Relationship, phone number *
What are your goals? *
Required
What do you need help with?
I give Rose City Learning Center permission to use my name, photograph, video, and/or quotes for educational and promotional purposes. I also understand I can withdraw consent at any time by notifying the Center in writing.  /   Autorizo ​​al Centro de Aprendizaje Rose City a usar mi nombre, fotografía, video y/o citas con fines educativos y promocionales. Entiendo que puedo revocar mi consentimiento en cualquier momento notificándolo por escrito al Centro./ Mwen bay Sant Aprantisaj Rose City pèmisyon pou itilize non mwen, foto mwen, videyo mwen, ak/oswa sitasyon mwen pou rezon edikatif ak pwomosyonèl. Mwen konprann tou mwen ka retire konsantman mwen nenpòt ki lè lè mwen avize Sant lan alekri./ 我授权玫瑰城学习中心使用我的姓名、照片、视频和/或引言用于教育和宣传目的。我理解我可以随时以书面形式通知中心撤回此许可。
Wǒ shòuquán méiguī chéng xuéxí zhōngxīn shǐyòng wǒ de xìngmíng, zhàopiàn, shìpín hé/huò yǐnyán yòng yú jiàoyù hé xuānchuán mùdì. Wǒ lǐjiě wǒ kěyǐ suíshí yǐ shūmiàn xíngshì tōngzhī zhōngxīn chèhuí cǐ xǔkě.
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