Celebration Languages

							Celebration
                                                Languages

            Please print and mail Page 2 of this document to:

                      Celebration Languages, LC
                    215 Celebration Place, Suite 500
                            Celebration, FL
                                 34747




             215 Celebration Pl. Suite 500 ♦ Celebration, FL, 34747
                              Tel: (407) 566-8421
  Rosario.Ramirez@CelebrationLanguages.com ♦ www.celebrationlanguages.com
                       Celebration                     Languages
                                                        APPLICATION FOR ENROLLMENT 2005

    Name of Student: ____________________________________________________________
    Address: ___________________________________________________________________
    Home Phone: (______) _________________ Work Phone: (______) __________________
    E-mail: ______________________________ Date of Birth: MM/DD/YYYY ___/___/_____
    Language(s) Spoken: ___________________ Target Language: _______________________
    Course Title and Schedule Requested:____________________________________________
    Current Education Level:     K 1 2 3 4 5 6 7 8 9 10 11 12
                                 College       Postgraduate         Professional
    Emergency Contact: __________________________________________________________
    Address: ___________________________________________________________________
    Phone: (______) _____________________ Relationship: ___________________________
    How did you hear about Celebration Languages? ___________________________________
    Questions or Comments _______________________________________________________



_______________________________________            __________________________________________
Student Signature              DATE                Parent or legal guardian           DATE
Please print name and sign.                        Please print name and sign.
                                                   (Required if student is under 18 years of age)




    If student is under 18 years of age, parent or legal guardian must fill out the following section:

    Parent or Legal Guardian name: _________________________________________________
    Address (if different from above): ________________________________________________
                                     ________________________________________________
    E-Mail: _____________________________________________________________________
    Home Phone: (______) _________________ Work Phone: (______) ___________________


                          215 Celebration Pl. Suite 500 ♦ Celebration, FL, 34747
                                           Tel: (407) 566-8421
               Rosario.Ramirez@CelebrationLanguages.com ♦ www.celebrationlanguages.com