Lake Norman Language Academy Children Registration Form
We appreciate your interest in the classes! Muchas gracias!
You can reach us at info@LKNLanguageAcademy.com Phone: 704-253-3361 www.LKNLanguageAcademy.com
Group class name
Answer only if you're taking a group class
Your answer
First Name *
Student
Your answer
Last Name *
Student
Your answer
Birthdate
MM
/
DD
/
YYYY
School Name
Your answer
Grade *
Your answer
Age *
Your answer
Male or Female
Parents' Names *
Your answer
Teacher's Name
Info needed only for School classes
Your answer
Home Phone *
Your answer
Cellular Phone *
Your answer
E-mail address *
Your answer
Address
Your answer
Emergency Contact Name and Phone number
Your answer
Payment amount
In order to complete your registration process our company needs to receive your payment. Gracias!
Your answer
Payment Type *
Required
Special Needs/Allergies/Concerns *
Your answer
PHOTO/VIDEO RELEASE
I give my permission to Lake Norman Language Academy, Inc. to use photos/videos of my child/children on its social media and/or in printed materials, and in electronic forms of communication. By signing your child to this class you agree to this. Gracias!
Your answer
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