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 *
Child's last name *
Child Grade and school name *
Does child have any allergies or special needs? *
Please give details
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 *
Check the items below indicating authorization *
Regarding refunds *
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?
Please make checks out to:
Culture Club
3145 NE Flanders St.
Portland, OR 97232
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