The World LANGUAGE HOUSE
Registration Form 2011
FOR WHICH CLASS(ES) ARE YOU REGISTERING? ____________________________________________________
ON WHAT DAY & AT WHAT TIME IS/ARE THE CLASS(es)? _____________________________________________
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STUDENT’S NAME:
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Address:
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City/State/Zip:
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Phone Numbers:
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E-Mail Address:
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Previous Experience with this Language?
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Allergies:
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Emergency Contacts/Numbers during Class Time:
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The following FEES are due with this form:
2nd Semester Registration Only = $20/student
Regular Registration = $50/student + 1/2 month's class tuition
(Maximum Registration Fee of $90/Family. Registration Fee is NON-REFUNDABLE . . . except
Registration Fees and Tuition are fully-refundable within 3 days of receipt or if course is cancelled by The World Language House.)
Enclose cash or check payable to:
The World LANGUAGE HOUSE
605 Muriel St., Richland, WA 99352
(509) 627-7111 or 378-9751
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RE: The World LANGUAGE HOUSE, ITS TEACHERS, & ITS STAFF
For: _________________________________________________________
Name(s)
RELEASE OF LIABILITY
We will extend every effort to watch out for you and/or your children with the same amount of care and concern as we would ourselves and/or our own. In the case of an unexpected accident, however, which results in injury to you and/or your child, you agree to hold harmless Patricia Skirko/The World Language House and its teachers from any damages and/or medical expenses incurred.
I agree: _____________________________
Signature
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Printed Name
Dated this _______ day of ______________, 2012
