Child/Teen Reg Form (Private Class) - Capital Region Language Center

Child/Teen Registration Form (Private Class)

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

Registration

Thank 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/Guardian

Name(Required)

First Last

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

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 Information

Name(Required)

First Last

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

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

Please describe any food allergies that we should know about:(Required)

Language Course Information

Language 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 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

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

Phone

Relationship

How 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

Radio advertising

Facebook

Instagram

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 Policies

Capital Region Language Center Policies(Required)

Please initial below. I_________________________(parent/guardian name), understand that...

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

In the event that my child cannot attend a group class, and I have provided at least two business days' notice, my child will be allowed to attend any other group class in the language they are 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. If my child is a private class student, we will be given up to two opportunities to reschedule the class time as long as I provide at least two business days' written notice to both the 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 my child would like to bring a guest, I will seek permission from the instructor and a CRLC staff member.

I understand that my child 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 the 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 the 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

Photo Authorization

I, ___________________________________ (parent/guardian 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 child's 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 child's photograph, video or audio file. I understand that my child might be identified by name in photographs, video or audio files. I have read this authorization, and I understand its contents.

Signature(Required)

Payment Options

By Check - 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.

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

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

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.

Payment Information

Payment Information(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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