Culture Club - 2019/20 School Year Enrollment Laurelhurst - Beginner French
Beginner French - Wednesdays 3:30-4:30, Starting September 18th, Minimum enrollment required
Email *
Student Information
Has the child studied a second language before? *
Child's first name *
Child's last name *
Child's age *
Does child have any allergies or special needs? *
Please give details
Please explain *
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 authorisation *
I understand and commit to the following: *
Payment Options
Payment by Venmo @ Jamie-Michaud or check made out to Culture Club on first day of class
Payment choices (30 sessions) *
Would you like to contribute to a scholarship fund?
Clear selection
Please make checks out to:
Culture Club
3145 NE Flanders St.
Portland, OR 97232
How did you hear about us? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy