Adult Reg Form (Private Class) - Capital Region Language Center

Adult Registration Form (Private Class)

This field is for validation purposes and should be left unchanged.

Register for a private language class with the Capital Region Language Center (CRLC). Please provide the requested information to help us tailor your learning experience. The information obtained is kept for internal purposes only.

Thank you for registering with CRLC!

You acknowledge that you are registering for a private class.(Required)

Yes

No, I must click here and fill out a different form

Name(Required)

First Last

Preferred name / nickname:

Preferred pronouns:

Email(Required)

Birthday (optional)

Please share your birthday (month/day) so we can celebrate with you!

Age Group

For internal purposes only*

Young Adult (18-29)

Adult (30-39)

Adult (40-49)

Adult (50+)

Contact Information

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone

Work Phone

Home Phone

I understand that my instructor will have my contact information and that I may receive language-specific and general CRLC emails and/or calls(Required)

Language Course Information

Registering for:(Required)

Virtual

In-person classes

Language you are registering for:(Required)

Course Information (If you do not know course options, please provide your availability.)

Day Time

What are your primary goals for taking a private language class?

Please check all that apply*

Select All

Academic Study

Cognitive Enrichment

Family/Relationships

Professional Development/Business Needs

Travel/Cultural Enrichment

Other (please fill in below)

How long do you hope to study this language?

One session

One year

1+ years

How did you hear about Capital Region Language Center (CRLC)? Check all that apply:(Required)

I am a former student

Another student's recommendation (please provide name)

Word of mouth

The LEAP! program

Networking/Community Event

Web search (Google, Bing, etc.)

WAMC underwriting

Facebook

Instagram

AI search

Other (please fill in below)

Other way you heard about CRLC?

Name of student who recommended you?

First Last

Please share any specific topics, materials, or challenges you would like us to address in your private class

Capital Region Language Center Policies

Please read thoroughly*

Enrollment & Session Structure(Required)

A. I understand that my payment reserves mutually agreed-upon instructional time and that all fees are non-refundable once a session has begun.

(Required)

B. The instructional time is scheduled to occur on the same day(s) and at the same time weekly.

(Required)

C. I understand that my session must be completed within the designated session dates provided in my class confirmation email. Unused classes after this period do not transfer to future sessions and will be forfeited.

(Required)

D. I understand that approved rescheduled classes must take place within the designated session dates and may not extend the session end date.

Attendance, Rescheduling, & Cancellations(Required)

A. I understand that I am allowed to reschedule up to two classes per session provided I give the office and my instructor at least 48 business hours’ written notice. (For a Monday class, notice must be received on the Thursday before.)

(Required)

B. I understand that cancellations made with less than 48 business hours’ notice will result in a forfeited class.

(Required)

C. I understand that repeated late cancellations within a session may result in may require payment of future sessions in full or private instruction not being an option for future sessions.

(Required)

D. I understand that exceptions to the attendance policy may be considered in the event of extenuating circumstances such as a serious medical condition or the death of a family member. Documentation may be required.

Instructional Standards & Professional Conduct(Required)

A. I understand that consistent attendance supports both my progress and the effective use of scheduled instructional time.

(Required)

B. I understand that CRLC reserves the right to review attendance patterns and make enrollment decisions in the best interest of the instructional community.

(Required)

C. I understand that CRLC reserves the right to decline renewal for a 1:1 course if attendance patterns disrupt instructional continuity and that a group class option may be suggested when appropriate.

(Required)

D. I understand that I may have a substitute teacher if the instructor is unable to fulfill their responsibilities.

Observation, Recording, & Media(Required)

A. I understand that classes may be observed by CRLC staff or approved visitors with prior authorization from the center director.

(Required)

B. I understand that teachers and staff may be photographed, videotaped, or audiotaped during class time for marketing or training purposes.

(Required)

C. I understand that classes may be recorded for training purposes.

Authorization for Use of Photos, Audio and/or Video Recordings of Class(Required)

I permit and authorize Capital Region Language Center, LLC (CRLC) and its employees, agents, and personnel who are acting on behalf of CRLC to photograph, video or audio record me for purposes related to the educational mission of CRLC including publicity, marketing, and promotion of CRLC and its various programs. I understand that a photograph, video or audio file may be copied and distributed by means of various media, including video presentations, television, news bulletins, mail outs, billboards or signs, brochures, placement on CRLC’s website, or newspapers. I understand that, although CRLC will endeavor to use my photograph, video or audio recording in accordance with standards of good judgment, CRLC cannot guarantee that any further dissemination of the photograph, video or audio file will be subject to CRLC supervision or control. Accordingly, I release Capital Region Language Center from any and all liability related to dissemination of my photograph, video or audio file. I understand that I might be identified by name in photographs, video or audio files. I have read this authorization, and I understand its contents. Photo, audio and video will be used for promotional purposes only*

Payment Options

Payment Options(Required)

ACH (Full Payment): I will pay the full session tuition via ACH (bank transfer) through the payment link on my invoice.

Credit Card (Full Payment): I will pay the full session tuition by credit card through the payment link on my invoice. Please note: Credit card processing fees apply.

Credit Card (Recurring Payments): I authorize CRLC to process recurring monthly payments to my credit card on the first of each month until the total tuition balance is paid in full. Please note: Credit card processing fees apply to each transaction.

Pay In Full Procedures(Required)

Following the submission of this form, you will receive an invoice via QuickBooks to the email entered above. Payment can be completed by clicking "review and pay." Please contact the office if you are unable to locate your invoice. Please note: registration is not complete until CRLC has received payment for the full session.

By checking this box, I acknowledge that I have fully read and understood the billing policy.

Recurring Payment Authorization

Please click HERE to read about the recurring payment authorization. By signing below and submitting this registration form, I am confirming that I agree to the terms outlined in the recurring payment authorization.

Invoice Notifications

Please check the box if you wish to have your invoice sent by text as well.

I agree to receive invoice notifications by text in addition to email.

Payment Information

Payment Information Agreement(Required)

Enrollment is for the full session as reflected on your invoice, which will include the applicable course dates and tuition amount. Payment must be received prior to the first class. By selecting “I Agree,” I acknowledge that I have read and understand these terms and accept responsibility for timely payment. A copy of my responses will be sent to me via the email I have provided in this form. By checking this box, I acknowledge that I have fully read and understood the billing policy.

I agree.

CRLC's Privacy Policy

Click here to read our privacy policy.

By submitting this form, I have read and agreed to CRLC's Privacy Policy.

Please provide your signature by typing your full name in below

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