Spanish Classes start 09/20/ 2010
www.iberianamericanlanguage.com
E-mail: info@iberianamericanlanguage.com
Tel: (718) 501-7661 / Cell: (917) 805-1232
We offer an authentic year round Spanish after school program on Mondays at PS 183. We provide
a safe and encouraging atmosphere to learn Spanish by experienced native teachers for Pre K to 5th
Graders.
* The price is $560.00 per semester. The space is limited and a minimum of 6 (six) children are
required to hold the class. We offer a 10% sibling discount.
* The price includes materials and refreshments. Healthy snacks will be provided.
* Withdrawals and refunds: If a parent withdraws a student from this program within the first two
classes (two weeks), any tuition will be returned to the parents, minus a $60.00 charge to cover the
cost incurred for those weeks. There will be no refunds, for any reason after the second week.
Children must be pick up at (time), depending of the class that you registered. Any check rejected will
be charged a $35.00 fee
* We will e-mail you the confirmation of your child in the program
* Please Read and complete (print legibly) the entire form and return it with your payment
before September 17, 2010 to: “Iberian-American Language Institute”
c/o Maria Ruscelli.
68-37 Yellowstone Blvd. Apt. D26
Forest Hills, NY 11375
.............Please Cut and Return it………………….............................................................
Child’s Name:__________________________ Age: ___ Grade: ______ D.O.B.__________
Parent or Guardian’s Name: _____________________________________________________
Authorize person to pick up the child:_____________________________________________
Address: ______________________________ Apt #: ______ City: _____ Zip Code: _______
E-mail: _______________________________________________________________________
Tel: _____________________ Cell Phone Number: ___________________________________
What language does he/she speak at home? _____If so, please state ____________________
Does your child have any allergies? Yes__No _If so, please state them___________________
Parent consent: I have read, understand and agree to Iberian American Language Institute
classes withdrawal and tuition policies. I understand that Iberian American Institute reserves the
rights to limit, deny or terminate enrolment and participation in order to maintain a safety program,
its students and staff.
Permission is given to photograph: ____ YES ____ NO
Permission is given for my child, ______________________________, to be photographed, videotaped
or otherwise recorded during classes, and for any such photographs to be displayed by Iberian
American Language Institute in any medium newsletters, web sites, etc., whether now or hereafter
knows nor developed.
Signature___________________ Print _____________________ Date: _________