Riverdale Elementary - Beginner French Culture Club School Year Enrollment
Beginner French - Mondays 3:30-4:30, Starting September 18th
Student Information
Has the child studied a second language before? *
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 give details
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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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Class information
Classes will be held on Mondays from 3:30 until 4:30
Classes will begin on September 18th. Minimum enrollment required
Authorization
Check the items below indicating authorisation *
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Commitment to a full school year of study
I understand and commit to the following: *
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Payment Options
I prefer to pay the yearly tuition *
Please make checks out to:
Culture Club
3145 NE Flanders St.
Portland, OR 97232
Other
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