World Languages for Children LLC

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*Today's date:

-- mm/dd/yy

*Enter your Child's Name:

Enter your Child's Preferred Name

*Enter your Child's birthday

-- mm/dd/yy

Please provide the following contact information:

* Parent/ Guardian
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
Work Phone
*Home Phone
*E-mail

*How did you hear about us? Choose one Billboard on Clemmons/Lewisville Rd Billboard on Country Club Rd Billboard on Stratford Rd Forsyth Family Magazine Grapevine Magazine Flyer in my mail Email NPR / WFDD radio station Banner Friend/Family

*I would like to enroll my child into the following class. Please note: class length is 30 minutes.

Choose Class

*Please indicate day of the week and time for the class (for availability click here: http://www.worldlanguagesforchildren.com/Class_Offering.htm)!

 

Registration Fee due at the time of registration. Individual Registration Fee is $25.00 per child, or $30 per family.
The Fee is non-refundable.  Please note: Except for newborns, siblings not enrolled may not accompany parent to class.

~ Credit Cards: A window will appear after submitting the Application Form

~ Checks: Please make checks payable to World Languages for Children LLC and send with a copy of the Application Form. Your application is not complete until we receive the payment.

World Languages For Children, LLC reserves the right to combine and /or cancel classes due to insufficient enrollment. In the event of cancellation, a refund will be issued.

Participation Waiver: As with any activity I understand there may be risk of injury or harm.  I agree to be solely  responsible for any medical expenses incurred by myself or my child(ren) while participating in World Languages For Children classes. I agree to hold Klarisa S.Cizmek, her family and staff, harmless from, and indemnify them for, any damage or loss arising as a result of my child(ren)'s photo taken during classes to be used for publicity purposes by Klarisa S. Cizmek. I hereby give my consent for any emergency medical treatment. This is to prevent any delay and insure prompt treatment if necessary. I understand only a licensed physician will be used for any such medical treatment.