CHILD/TEEN REGISTRATION FORM Registering for:(Required) Virtual classes In-person classes 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) Best way to contact you for general information: Cell Phone Work Phone Home Phone Email 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 InformationName(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 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) Are you registering your child for a private or group class?(Required) 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 you your child achieve their 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 PhoneRelationship 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 student 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 PoliciesPlease 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. My child is automatically registered for the subsequent course providing that the schedule remains the same. If my plan is to NOT have my child continue with the language course, I will let the instructor and a CRLC staff member know, in writing, no less than two weeks prior to the last class date. 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 ClassI, ___________________________________ (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, 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 InformationWhen 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. Payment for the course is made in advance of the first class of the session and can come in 3 forms of payment; cash, check, or charge. If you are paying cash, please coordinate with the business office. Please send checks to the Albany address listed at the top of this registration form. Credit card payments must be made via the Payment Option Form which is available for download on the website's registration page, or by calling the office to provide payment information. 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)Payment OptionsPayment 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 call the office to provide my credit card information, will schedule a time to stop by the office to pay in person, or I will print the Payment Options Form from the website and mail it in. 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. Click here to read about the recurring payment authorizationCAPTCHACommentsThis field is for validation purposes and should be left unchanged.