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

Adult Registration Form (Private Class)

Company

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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

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

Yes

No, I must fill out a different form.

Registering for:(Required)

Virtual

In-person classes

Contact Information

Name(Required)

First Last

Preferred pronouns:

Address(Required)

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

Cell Phone

Work Phone

Home Phone

Email(Required)

Best way to contact you for general information:

Cell Phone

Work Phone

Home Phone

Best way to contact you for a last-minute class cancellation:

Text Cell Phone

Call Cell Phone

Call Work Phone

Call Home Phone

Birthday (optional)

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

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)

For 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

If your classes are being sponsored by your employer, please provide the name of the company:

If your classes are being sponsored by your employer, please provide the name and contact information of your supervisor (if applicable) :

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

Radio advertising

Facebook

Instagram

Other (please fill in below)

Name of student who recommended you?

First Last

Other way you heard about CRLC?

All of the information provided above is correct and accurate. Signature:(Required)

Date(Required)

MM slash DD slash YYYY

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 at least two business days' 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 with the knowledge of a CRLC staff member. I understand that there may not be a class make-up option for me. If I am a private class student, I will be given up to two opportunities to reschedule my class time as long as I provide at least two business days' written notice to both my instructor and a CRLC staff member.

In the event that I or my child cancels a private class with less than two business days' notice, the class time will be forfeited.

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 a virtual class 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 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.

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.

Signature(Required)

Payment Options

Payment Options(Required)

Credit Card Recurring Payment - After my initial payment, I will pay monthly by credit card.

By Credit Card - I will pay in full for the session via credit card.

By Check or Cash - I will pay in full for the session and mail in or arrange to drop off my check. My registration is not complete until my check has been received by CRLC.

Recurring Payment Authorization(Required)

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 by Credit Card(Required)

To pay in full by credit card, I will be sent an invoice via email once my registration form is submitted. Payment can be completed using the “Review and pay” button in the email. If I do not see the invoice in my inbox, I will check my spam folder. If I do not see my invoice at all within 1-2 business days, I will let the CRLC office know. If I prefer to pay in person, I will schedule a time to stop by the office to pay. My registration is not complete until my payment has been made.

Invoice notifications

I agree to receive invoice notifications from CRLC by text and email.

Pay In Full by Check or Cash(Required)

To pay in full by check or cash, I will be sent an invoice via email once my registration form is submitted. Checks for the full amount provided on the invoice can be made out to Capital Region Language Center and mailed to 21 Aviation Rd. Albany, NY 12205 or delivered in person to our office at the same address. Cash must be delivered in person. My registration is not complete until my payment has been received.

Payment Information

Payment Information Agreement(Required)

When registering for classes with CRLC, you are registering for an initial session with subsequent sessions to follow. Initial course dates will be provided in your invoice. If you are paying cash, please coordinate with the business office. Please send checks to the Albany address listed on our contact page. Credit card payments must be either up front in full, or monthly with a recurring payment. Payment must be made prior to the first class. There is a $35 returned check fee for returned checks. Invoices are sent by email. I have read this policy, and I understand its contents.

Signature(Required)

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Consent

I agree to the privacy policy.