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									Language Latitudes, LLC
Class Registration Form

Student’s Name/Parent’s Name (if registering for child):
Address:
City:                                                   State:                                        Zip:
Phone: home                                                               cell
Email*:
*email will only be used for direct communications from Language Latitudes, LLC and information of further class offerings .

Preferred mode of contact (please circle):                home tel          cell        email           US mail
Class offering interest (please include day and time):
Previous experience with Spanish or any other foreign languages:




Please explain your interest in taking Spanish:




                                            *--------------------------*
If registration is for Children’s programs, please complete the information below:

Child’s name:                                                                                Age:
Child’s name:                                                                                Age:
Class time preference:
1st choice: Monday 9:45-10:45 a.m.                    1:30-2:30 p.m.                       3:00-4:00 p.m.
2nd choice: Monday 9:45-10:45 a.m.                    1:30-2:30 p.m.                       3:00-4:00 p.m.
3rd choice: Monday 9:45-10:45 a.m.                    1:30-2:30 p.m.                       3:00-4:00 p.m.
Liability Waiver:
By signing this registration, I acknowledge that Language Latitudes, LLC is organized for educational purposes only and is not
intended in any manner to be, with regard to the registration of children into children’s classes, child care during any Language
Latitudes, LLC class, program or event. I represent, acknowlege and agree that I am fully responsable for the safety and behavior of
myself, each member of my family and any guests accompanying me or my family at any and all Language Latitudes, LLC classes,
programs or events and at any and all locations that they might occur.
I hereby expressly release all claims which may arise on my behalf or on the behalf of any of my family members or guests as against
Language Latitudes, LLC, its owner, members, agents, attorneys or insurers including any and all damages, losses, costs, expenses,
attorney’s fees, any liabilities of every kind including passive or active negligence and strict liability, which might arise out of any
injuries or other damage allegedly suffered by me, any member of my family, or guest accompanying me or my family at any
Language Latitudes, LLC class, program or event, or in connection with any Language Latitudes, LLC activities.

Name (please print):
Signature:                                                                         Date:

								
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