Registration Form

Private Lessons for children / adults

Below please find the Enrollment Form, Program Description, Program Policies and Media Release Form, to be read in their entirety. Participants, please fill out the following information and submit to send this form to Deutsche Sprachschulen Colorado (DSS Colorado). This form is required to participate in the language program. The form MUST BE COMPLETE.
Enrollment Information
Enrollment Information*

Private Lessons : in-personPrivate Lessons : online
Participant*

AdultChild / Youth
Participant's Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Level*
Preferred Day for Lessons*
Participant's Name (additional Participant)

First NameLast Name
Date of Birth

MonthDayYear
Date
Level
Preferred Day for Lessons
Participant's Name (additional Participant)

First NameLast Name
Date of Birth

MonthDayYear
Date
Level
Preferred Day for Lessons
Participant's Name (additional Participant)

First NameLast Name
Date of Birth

MonthDayYear
Date
Level
Preferred Day for Lessons
Daytime Phone

Area CodePhone Number
Evening Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
E-mail*
Home Address (Street, City, Zip Code)*
Mailing Address (Street, City, Zip Code)*
Additional Comments

Emergency Contact

(Optional)
Does you have health insurance?

YesNo
Insurance Company
Policy #
Family Doctor Name
Phone Number
Preferred Hospital
In case of emergency, please notify:
Relationship to participant
Phone Number(s)
Please list any current medications, medical conditions, recent injuries, and food or drug allergies:

Program Description
The DSS Colorado Language Immersion Program is a full immersion language program for children and adults.

The DSS Colorado Language Immersion Program mission is to provide German programs to the Denver and surrounding communities.

CLASSES OFFERED:

DSS Colorado offers a variety of German specific courses for children and adults as well as summer classes for children and adults. Please see our website: www.dsscolo.org for specific classes and schedule.

For more info, contact…

Deutsche Sprachschulen Colorado

www.dsscolo.org

Phone: 303-928-0092

Website: www.dsscolo.org
Program Policies
ENROLLMENT:

• A completed Enrollment Information Form and a signed Participant/Guardian Release Form must be returned to Deutsche Sprachschulen Colorado to enroll.

. Private lessons are billed monthly and 3 sessions are billed in advance. Lessons need to be canceled 24 hrs prior to the scheduled class time to avoid charges.

• Classes canceled by the teacher will not be billed to the participant.

• The schedule will be confirmed by our Program Director via email.

• The organization admits students of any race, color, national origin, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national origin, and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and other school-administered programs.

ATTENDANCE:

• None of our classes are offered on a drop-in basis.

• Private lessons may be scheduled flexibly as long as the teacher confirms to the proposed change.

• Make-up sessions are available only when class is cancelled or if the school needs to reschedule a class.

• DSS Colorado shall not provide refunds for unattended but scheduled lessons.

FOLLOW PROGRAM RULES POLICIES:

• Participants are expected to show and display respect and cooperation with all program staff, instructors, volunteers, and participants at all times.

PARTICIPANTS:

• Please keep us updated with your current mailing address and phone numbers at all times so that we may contact you as needed.

• We encourage participants to interact with the Program Staff and ask questions or provide feedback.

CONSEQUENCES:

• DSS Colorado has a discipline policy that gives positive guidance, allows for redirection, and sets clear behavior limits. The discipline policy has been designed to assist participants and staff in developing self-control, self-respect, respect for others, and consideration for the rights and property of others.

• Participants that do not follow the above listed requirements and policies may receive, a phone call home, suspension from the program, or they may be dropped from the program. It is our intent to work closely with parents/guardians to resolve any recurring discipline issues.

PARTICIPANT TERMINATION POLICY:

• Participants will forfeit their space in the program for any of the following reasons:

o Behavior that threatens physical or emotional safety of others;

o Consistent disruptive behavior

COLLECTION POLICY AND CHARGES:

o Registration Fee and Prepayment of first 3 Classes shall be paid prior to first lesson by any enrolled participant, unless other payment arrangements have been made in writing with the Program Director.

o If collection efforts become necessary on any outstanding balances, DSS Colorado will be entitled to the late fee, costs of collection, including reasonable attorney fees, and such balances shall be subject to an interest charge at the rate of eighteen percent (18%) annually, compounding monthly.

ADDRESS/PHONE NUMBER CHANGES:

o Please keep DSS Colorado up-dated with any address or phone number changes for your home or work. It is critical to have accurate information for notices and in case of a necessary emergency contact.
Electronic Signature
Please type First and Last Name of Participant (if over 18)*
Date*

MonthDayYear
Date
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above PROGRAM POLICIES

Participant Release
Participants, please read carefully, sign, and return this form to Deutsche Sprachschulen Colorado. A participant signature on this form is required to participate in any of our programs.

For Emergency Treatment

I authorize DEUTSCHE SPRACHSCHULEN COLORADO to arrange for transportation in case of accident or acute illness of the participant. In the event it is not possible to receive instruction for the participant’s care, consent is given to any licensed physician for treatment. I allow the physician to administer medication and to perform necessary treatment for the preservation of the participant’s health and well-being. I understand that any cost incurred for treatment of sudden illness or accident shall be paid by me. This authorization and consent for treatment is given to DEUTSCHE SPRACHSCHULEN COLORADO in conjunction with any authorized event.

General Release of Liability

In consideration for being allowed participant privileges in any program of DEUTSCHE SPRACHSCHULEN COLORADO, I hereby assume full responsibility for any risk of bodily injury, death, or property damage and/or while using the premises or any facilities or equipment hereon. I further agree to hold harmless the DEUTSCHE SPRACHSCHULEN COLORADO and its partners, directors, officers, employees, agents, and volunteers from any and all claims that may result from any action for damages, including but not limited, to such claims that may result from injury or death, accident or otherwise, during or arising in any way from said activity. I acknowledge that this General Release of Liability of DEUTSCHE SPRACHSCHULEN COLORADO and its partners is binding on me and not my heirs, personal representatives, successors, and assigns.

Field Trips

DEUTSCHE SPRACHSCHULEN COLORADO will take short field trips on occasion that are within the program community. While taking part in these community field trips I release DEUTSCHE SPRACHSCHULEN COLORADO from responsibility for any risk of bodily injury, death, or property damage as covered in the "General Release of Liability."

Media Release

I hereby consent to the use of my name, likeness and speech in any audio tape, video tape, film or photograph made in any DEUTSCHE SPRACHSCHULEN COLORADO activity for the business or publicity purposes of the DEUTSCHE SPRACHSCHULEN COLORADO and its partners. I understand that any participation offers no remuneration and that my name, likeness and speech may be edited, produced, recorded for duplication and distribution throughout the United Sates and abroad. I expressly release DEUTSCHE SPRACHSCHULEN COLORADO and its licensees, assignees, affiliates and successors from any privacy, defamation, or other claims have arising out of broadcast, exhibition, publication, or promotion of this program. Please sign the Media Release Exception Form if you do not agree to the media release. PLEASE SIGN BELOW AS REQUIREMENT TO PARTICIPATE IN ANY Of OUR PROGRAMS.
Name*

First NameLast Name
Date*

MonthDayYear
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above PARTICIPANT RELEASE
I do not consent to the media release and would like to be exempt from it.

In order to complete your registration and start scheduling your classes, you are required to pay the registration fee. This fee is due annually for each participant and covers billing and admin expenses.

All payments are processed securely via PayPal.
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Registration Fee$40.00
Due for each participant.

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Private Lessons for children / adults

Enrollment Information

Emergency Contact

Program Description

Program Policies

Participant Release