Lake Norman Language Academy Childrens/ Teens 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
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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
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Home Phone *
Your answer
Cellular Phone *
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E-mail address *
Your answer
Address
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Emergency Contact Name and Phone number
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Payment amount
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Payment Type *
Payment must be made in order to complete your registration process. Please make checks payable to Lake Norman Language Academy and mail it to 104 Trotter Ridge Dr. Mooresville, NC 28117.
Required
Special Needs/Allergies/Concerns *
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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!
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