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  Lingua Franca
                                 Building Bridges of Communication

Registration Form

Lingua Franca
Language and Tutoring School
Registration form 2007
Complete this form in full for each participant registering for a course.

Date        
Student First Name        
Student Last Name   
Date of Birth        Gender  MaleFemale     Age   
Street Address   
City        
State        Zipcode        

Language Experience
 (Years/Hours per week)

        Where        
Parent/Guardian Name        Home Phone   
Work Phone        Cell Phone   
Email   

Emergency Contact
              Name

        Phone   
Other Persons Authorized to Pick Up Student(s)
Name        Phone   
Name        Phone   

FAMILY DISCOUNT:
For two or more members of the family enrolled in any course, deduct 10% from the total tuition. 
The children enrolled must be the legal dependents of the parent requesting the discount. 
Relatives and guests do not count as family members.

To receive the family discount, list the name, age and course of other members enrolled.

Name        Age        Course   
Name        Age        Course   
Name        Age        Course   
Fill in the following information
Name of Course(s)                              Cost for Ten Weeks
          $   
          $   
Subtract 10% Family Discount          $   
Sub-total          $   
Total Due          $   

Payments:
We accept checks, money orders or cash. 
You will receive a written confirmation after we receive your registration form.

Cancellations:
There will be no reimbursements for cancellations received
after the first week of classes.