2019-20 SHAFFER SPANISH Registration Form
PLEASE PROVIDE ONE FORM FOR EACH CHILD REGISTERED
Email address *
Student Name and Grade in School (2019-20) *
Your answer
Student Gender
Your answer
Student Birthday
MM
/
DD
/
YYYY
Any special allergies or needs?
Your answer
Previous Background in Spanish?
Your answer
SPANISH CLASS SELECTION: Please indicate preferred class below. (Notes: All classes are held M/W from 8:05 - 8:50 a.m. For students in K-4, those advanced in Spanish may be placed one level above their regular grade.)
PARENT CONTACT INFORMATION
Please include first and last names of both parents as well as an emergency contact person.
Mother's Name
Your answer
Mother's E-mail
Your answer
Mother's Cell Number
Your answer
Father's Name
Your answer
Father's E-mail
Your answer
Father's Cell Number
Your answer
OTHER EMERGENCY CONTACT (Name & Cell #)
Your answer
Tuition Cost
40 Classes, M/W Schedule (8:05 - 8:50 a.m.)
Annual Tuition $560.00 + $15 Registration Fee
$575.00 = TOTAL COST (Please note: For Siblings registered in program, deduct $20 each for Family Discount.)

NEW! SPLIT PAYMENT OPTION - Pay half of Total Cost at time of registration; Balance is due by November 15, 2019.

Write your calculated tuition amount here for ONE Spanish Student:
Your answer
PLEASE COMPLETE the REGISTRATION PROCESS with TUITION PAYMENT AND PARENT SIGNATURE
To pay online, go to www.languagelogix.com and click on SHAFFER ELEMENTARY. We accept all major credit cards.
Checks should be written to Language Logix and mailed to LANGUAGE LOGIX, P.O. BOX 270204, LITTLETON, CO 80127.
CANCELLATION POLICY & PROCEDURES *
I HAVE READ AND I AGREE TO THE CANCELLATION POLICY & PROCEDURES LISTED ABOVE. *
Required
Electronic Signature (Parent/Guardian) *
Your answer
Thank you! We appreciate your support for Spanish enrichment at Shaffer Elementary. Carol Edwards, Program Director
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