Culture Club - 2019/20 School Year Enrollment Laurelhurst - Beginner French
Beginner French - Wednesdays 3:30-4:30, Starting September 18th, Minimum enrollment required
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Student Information
Has the child studied a second language before? *
Child's first name *
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Child's last name *
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Child's age *
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Parent Information
Mother's name *
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Cell phone *
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Email Address *
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Mailing Address *
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Languages spoken *
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Father's name *
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Email Address *
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Cell phone *
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Mailing Address (if different from mother) *
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Languages spoken *
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Emergency Contact
Emergency contact name *
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Relationship to child *
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Alternative pick-up
Alternative pick - up name *
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Phone *
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Authorisation
Check the items below indicating authorisation *
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I understand and commit to the following: *
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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?
Please make checks out to:
Culture Club
3145 NE Flanders St.
Portland, OR 97232
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