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Registration form for Private Instruction/Tutoring
$80/hr. + $5/ Additional Students |
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Cancelling/rescheduling a session - We require a 48 hour advance notice in order to reschedule a tutoring session. If the 48 hour advance notice is not received, you will be charged for the missed lesson.
Payment Plan -Monthly payment may be made via Autopay. A valid credit card with expiration date is required for Autopay monthly payments.
*We request clients 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 services off-site unless authorized by Language Leaders.
Mail form to: 4N135 Fox Mill Blvd. St. Charles, IL. 60175
Student Name: ____________________________________________
Home phone:__________________
Day(s)/Time of tutoring session:____________________________________________ Address:_________________________________City_________________Zip:_______
Cell Phone #1:_________________________Cell Phone #2:______________________
Work Phone #1:_______________________Work Phone #2:_____________________
Email Address:_________________________________________________________
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:_____
Name of cardholder:___________________________________________________
Card number:_________________________________________Exp. date: _______
Signature:_______________________________Amount:____________or Autopay
Security Code (the three digit code on the back of your card):___________________ |
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