Glen Grove Fall 2024 Spanish Club

Glen Grove Club Registration Form

The Language Academy LLC
Student Name 1*

First NameLast Name
Student Name 2

First NameLast Name
Birth Date 1*

MonthDayYear
Birth Date 2

MonthDayYear
Parent/Guardian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Alternate Number*

Area CodePhone Number
Allergies:*

YesNo
If yes, please provide additional information:
Other Medical Information:

My Products

14 Weeks - Mondays$210.00

Spanish Club will meet on Mondays: September 9, September 16, September 23. September 30, October 7, October 14, October 21, October 28, November 4, November 11, November 18, November 25, December 2, December 9

Children

Total $0.00

Credit Card

WAIVER AND RELEASE OF ALL CLAIMS

I understand that participation in the Program is voluntary, and voluntarily assume and accept personal responsibility for any injury, liability, loss or damage arising from any and all risks, known and unknown, foreseeable and unforeseeable, in any way connected with participation in the Program.

I, on behalf of myself and my child, release The Language Academy LLC and its management, teachers from any and all liability from property damage, personal injuries, or other claims arising from or in connection with my child participation in activities at or with The Language Academy LLC.

By agreeing to this form, I, as parent/guardian, permit The Language Academy LLC to use pictures of my child(ren) as a program participant in promotional literature, videos, and The Language Academy LLC website. I understand my child(ren)’s name(s) will not be published.

I have read and fully understand the above important information, waiver and release of all the claims.
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Glen Grove Club Registration Form

Credit Card