Registration Form, COLLAGE, 2020-2021

Registration Form, Fructuos 21-22

Let the English fun begin!
Full Name *

Name Middle Name / First Last Name Last Name / Second Last Name
School Grade (for 2020-2021 school year) *
DOB *

Day Month Year
Parent's Name *
Contact Number *
Parent's/ Caregiver's/ Other Name *
Contact Number *
Email Address *
example@example.com
Additional Email Address
example@example.com
Home Address (only necessary for in-home classes)

Street name, number, staircase, floor, apt. #, etc.

Numero (porta, escalera, pis)

City

Zipcode
Program

Jitterbugs Little Faces Little Actors Dynamic English Teen Actors Midday groups Saturdays Private Classes / Babysitting Group Adult English Art in English, Adults Creative Writing ONLINE Other
ONLINE OPCION: please state which program you are interested in doing online
Day

Monday Tuesday Wednesday Thursday Friday Saturday
Authorisation of Image Rights for Use of Photographs Taken During Class: I authorise CREATIVE LANGUAGE CENTER, SCP to use photographs taken during the activities to be later shared on social media sites in order to showcase the activities and share with the Collage public. *

YES NO
ADDITIONAL COMMENTS
Personal characteristics, allergies or medical issues we should know about, English experience/ background, etc
The annual registration fee is 60€, and it can be paid via direct debut (please fill in bank details below), or via a bank transfer to the following bank account:

Creative Language Center, SCP
La Caixa
IBAN: ES70 2100 1159 9301 0028 6899

Thank you for writing your or your child's name and "Registration 2020-2021" in the subject line of the transfer.
Bank Details
Account holder and DNI/ NIE
IBAN
24 digits, beginning with ES
I prefer to pay in cash at Collage (for the monthly fee)

Cash
I authorise COLLAGE to direct debit the annual registration fee and/ or the monthly class fees from my bank account stated above.

Los datos personales que constan en este documento están incorporados a un fichero cuya finalidad es la gestión de clientes y participantes en actividades, y del que es responsable CREATIVE LANGUAGE CENTER SCP, ante quien podrá revocar su consentimiento y ejercitar sus derechos conforme a la Ley Orgánica 15/1999 de 13 de diciembre, de protección de datos de carácter personal, mediante carta dirigida a la siguiente dirección: C/ Sant Salvador, 96 – bajos, 08024 Barcelona
Signature

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Registration Form, Fructuos 21-22