Child/Teen Registration Form (Private Class) CommentsThis field is for validation purposes and should be left unchanged.RegistrationThank you for registering with CRLC! Once your form is submitted, we will send you an invoice for your selected course. The invoice will include a one-time $75 registration fee for new students to CRLC in addition to the course tuition.Contact Information for Parent/GuardianName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell PhoneWork PhoneHome PhoneEmail(Required) Preferred contact method: Email Text Cell Phone Call Cell Phone Call Work Phone Call Home Phone Please initial: I understand that my child's instructor will have my contact information and that I may receive language-specific and general CRLC emails and/or calls:(Required)Child/Teen InformationName(Required) First Last Preferred pronouns:Preferred name / nickname:Date of Birth:(Required) Month Day Year Grade Level:(Required)Does your child have any special physical needs that we should know about? If yes, please describe below.(Required) Yes No Please describe any special physical needs that we should know about:(Required)Does your child have any food allergies? If yes, please describe below.(Required) Yes No Please describe any food allergies that we should know about:(Required)Language Course InformationLanguage you are registering your child for:(Required)Course Information (If you do not know the class schedule, please provide your child's availability.) Day Time I understand that I am registering my child/teen for a private class.(Required) Yes, I understand. No, I must click here and fill out a different form Registering for:(Required) Virtual classes In-person classes For how long do you plan to have your child study this language? Just One Session About One Year More Than One Year Not Sure Yet Why is your child studying this language?In addition to teaching, how can we help your child achieve their language-learning goals?What types of virtual or in-person events would you like us to host?Would you be interested taking a language immersion trip organized by CRLC with your child and/or your family? Yes No Maybe Please list other adults who have permission to pick up your child from CRLC if your child is attending in-person classes. First Last PhoneRelationshipHow did you hear about Capital Region Language Center (CRLC)? Check all that apply:(Required) I am a former student My child is a former student Another student's recommendation (please provide name below) Word of mouth The LEAP! program WAMC underwriting Facebook Instagram LinkedIn Reddit Other (please fill in below) Name of person who recommended you? First Last Other way you heard about CRLC?All of the information provided above is correct and accurate.(Required)Date(Required) MM slash DD slash YYYY Capital Region Language Center PoliciesEnrollment & Session Structure(Required) A. I understand that my payment reserves mutually agreed-upon instructional time for my child and that all fees are non-refundable once a session has begun. (Required) B. I understand that my child’s instructional time is scheduled to occur on the same day(s) and at the same time each week. (Required) C. I understand that my child’s session must be completed within the designated session dates provided in the 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 for my child 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 may reschedule up to two classes per session for my child provided I give the office and instructor at least 48 business hours’ written notice. (For a Monday class, notice must be received on the preceding Thursday.) (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 require payment of future sessions in full or may result in private instruction not being available 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 my child’s 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 a substitute teacher may be assigned 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. I have read and agreed to CRLC's policies.(Required)Authorization for Use of Photos, Audio and/or Video Recordings of ClassPlease sign below. Authorization for Media(Required) I, (parent/guardian), do 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 my student 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 student's 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 student's photograph, video or audio file. I understand that my student might be identified by name in photographs, video or audio files. I have read this authorization, and I understand its contents. I, (parent/guardian), do NOT 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 my student for purposes related to the educational mission of CRLC including publicity, marketing, and promotion of CRLC and its various programs. Signature(Required)Payment OptionsPayment 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. Recurring Payments 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.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. Invoice NotificationsPlease 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 InformationPayment 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. I agree. Signature(Required)Privacy PolicyClick here to read our privacy policy. By submitting this form, I have read and agreed to CRLC's Privacy Policy.
