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Register for classes via email, mail or fax!
Cut and paste registration
form and email to mbeitz6776@aol.com
OR
Mail form to:
4N135 Fox Mill Blvd
St. Charles, IL. 60175
OR
Print and Fax form to: 630-578-0948
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Registration form for Language Classes
401 W. State St.
Geneva, IL. 60134
630-232-2001 Fax: 630-578-0948 |
Please complete one form per student |
*Absences
Please call if your child is sick and going to be absent.
I am registering for the _____________________class on ________________ from ______-______.
(Class) (day(s) of week) (time)
Register by Fax: Fax registration and credit card information to 630-578-0948.
Register by Mail: Mail completed form and payment to 401 State St. Geneva, IL. 60134
Please complete one form for each student. Make check payable to: Language Leaders
Name of Student:________________________________________________DOB:___________
Parent name:_____________________________________________________________________
Street:_________________________________________City___________________Zip________
Home phone:_________________________Cell phone:__________________________________
Emergency contact:_________________________________Phone:_________________________
Email address:____________________________________________________________________
We will confirm your registration via email. Email addresses are kept confidential.
Please make check payable to : Language Leaders
AutoPay (tuition is broken down into equal monthly payments) I would like to sign up for AutoPay and have my credit card charged on the 1st of each month. I understand that in order to cancel Autopayment, I must call the billing center at 630-232-2001 before the 1st day of the month.
_____________________________________________
(signature)
credit card information is kept confidential and only viewed by company owner.
Credit Card Payment Visa:____ Mastercard:_____
Cardholder:______________________Card number:______________________Exp. date: _______
Signature:___________________________________________Amount:____________or Autopay
Security Code (the three digit code on the back of your card) ______________________
Language Leaders welcomes all students to participate in its program regardless of religious background, however, please note Christian principles and holidays are taught and celebrated.
We request parents and students do not solicit Language Leaders teaching staff for any services that are not performed on- site at the Language Leaders facility. For liability purposes, teaching staff is prohibited from providing instructional services off-site without company authorization. |
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