Culture Club - Fall 2019 Enrollment Alameda - Beginner French
Beginner French - Thursdays 3:00-4:00, Starting Sept. 19th - Ending Dec. 5th (No Class November 21st)
Email address *
Class information
Classes will be held on Thursdays days from 3:00 until 4:00
Classes will begin on Sept.19th. Minimum enrollment required
Student Information
Has the child studied a second language before? *
Child's first name *
Your answer
Child's last name *
Your answer
Child Grade and school name *
Your answer
Does child have any allergies or special needs? *
Required
Please give details
Your answer
Parent Information
Mother's name *
Your answer
Cell phone *
Your answer
Email Address *
Your answer
Mailing Address *
Your answer
Languages spoken *
Your answer
Father's name *
Your answer
Email Address *
Your answer
Cell phone *
Your answer
Mailing Address (if different from mother) *
Your answer
Languages spoken *
Your answer
Emergency Contact
Emergency contact name *
Your answer
Phone *
Your answer
Relationship to child *
Your answer
Alternative pick-up
Alternative pick - up name *
Your answer
Phone *
Your answer
Relationship to child *
Your answer
Authorisation
Check the items below indicating authorization *
Required
Regarding refunds *
Required
Regarding late payments *
Payment Options
Once enrollment is complete you will receive an invoice. Please choose your payment choice. *
How did you hear about us?
Your answer
Please make checks out to:
Culture Club
3145 NE Flanders St.
Portland, OR 97232
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service