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
* Required
Group class name
Answer only if you're taking a group class
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First Name
*
Student
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Last Name
*
Student
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Birthdate
MM
/
DD
/
YYYY
School Name
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Grade
*
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Age
*
Your answer
Male or Female
Male
Female
Parents' Names
*
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Teacher's Name
Info needed only for School classes
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Home Phone
*
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Cellular Phone
*
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E-mail address
*
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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.
Cash
Check
Paypal
Other:
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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