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

Adult Registration Form (Group Class)

Company

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

Registration

Thank you for registering with CRLC!

Language Course Information

Language you are registering for:(Required)

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

Day Time

I acknowledge that I am registering for a group class.(Required)

Yes

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

Registering for:(Required)

Virtual

In-person classes

Contact Information

Name(Required)

First Last

Preferred pronouns:

Preferred name/nickname:

Address(Required)

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

Cell Phone

Work Phone

Home Phone

Email(Required)

Please initial: 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)

Birthday (optional)

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

How long do you hope to study this language?

Just One Session

About One Year

More Than One Year

What do you hope to do with your new language skills?

In addition to teaching, how can we help you achieve your language-proficiency 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?

Yes

Maybe

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

WAMC underwriting

Facebook

Instagram

Other (please fill in below)

Name of student who recommended you?

First Last

How did you hear about Capital Region Language Center (CRLC)?

Capital Region Language Center Policies

CRLC Policies(Required)

I (student name), understand that...

I am registering for a session of classes and that neither a refund nor a credit will be issued if I choose to drop the class.

In the event that I cannot attend a group class and I have provided notice, I am allowed to attend any other group class in the language I am studying. This make up class should be completed within the current class session. I will contact the office to confirm available make up class times. I understand that there may not be a class make-up option for me.

Classes are designed for registered CRLC students, and if I would like to bring a guest, I will seek permission from the instructor and a CRLC staff member.

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

If CRLC cancels a class, it will be made up within the session at an agreed upon time, or my session dates will be extended to allow for the class to be made up.

If a weather condition or other emergency prevents CRLC from holding my class at the regularly-scheduled time, I will call or be sure to check my messages in case CRLC has contacted me.

Classes may be observed by CRLC staff or non-staff members who have sought previous permission from CRLC's director.

Teachers and other staff may be photographed, videotaped, or audiotaped during my class time for marketing or training purposes.

I understand that classes might be recorded for training purposes.

Signature(Required)

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

Authorization for Media(Required)

I, ___________________________________ (student name) 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 class 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 & social media, or newspapers. I understand that, although CRLC will endeavor to use the 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.

I, ___________________________________ (student name) 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 me for purposes related to the educational mission of CRLC including publicity, marketing, and promotion of CRLC and its various programs.

Payment Options

Select your preferred payment method:(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 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.

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 Notifications

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.

Invoice Notifications

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.

I agree.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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.