LEAP! 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 School Name:(Required) Grade Level:(Required) Classroom Teacher's Name: First Last 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 special learning or behavioral challenges that we should know about? If yes, please describe below.(Required) Yes No Please describe any special learning or behavioral challenges 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 Class InformationLanguage you are registering your child for:(Required) Day and time of the class you want to register your child for:(Required) If other languages are offered, do you have a second choice of language and day? If yes, please fill in below.(Required) Yes No What is your second choice of language and day?(Required) Does your child have any previous exposure to languages? If yes, please describe below.(Required) Yes No Please describe your child's previous exposure to languages.(Required)Why is your child studying this language? LEAP! ProgramName First Last PhoneHow did you hear about the LEAP! program? Check all that apply:(Required) I am a former language student of Capital Region Language Center My child is a former student of Capital Region Language Center My child has attended a LEAP! program n the past. My child's school or teacher Radio advertising Facebook Instagram Website Other (please fill in below) 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 or if my child is absent from class. I understand that my child may have a substitute teacher if the instructor is unable to fulfill their responsibilities. If CRLC cancels a class, the session dates may 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 and/or my child's school has contacted me. Classes may be observed by CRLC staff members who have sought previous permission from CRLC's director. My child is not automatically registered for a subsequent LEAP! session. LEAP! is an enrichment program and there will not be required homework. I must present personal identification in order to pick up my child from the LEAP! program. I, or others who have permission to pick up my child, will arrive on time, or I may incur additional charges. Signature(Required)Payment PolicyWhen registering for a LEAP! session with CRLC, you are registering for one complete session. Payment in full is required in order to register my child for LEAP!. If the LEAP! program does not run do to under enrollment, I will be refunded in full via Paypal or by check.Signature(Required)CAPTCHAEmailThis field is for validation purposes and should be left unchanged.