Name _____________________________________________________ Age (child) _________ 

Language______________________Class Day & Time _______________________________

Session Dates: ________________________________________________________________


Street Address _________________________________________________________________

City & Zip_______________________________________________________________________

Parent Name(s) _________________________________________________________________

E-mail___________________________________________________________________________

Home Phone____________________Work __________________Cell_____________________

Other Emergency Contact _________________________Phone ________________________

Your registration will be confirmed via phone or email before the start of classes. 
No refunds will be issued after classes begin.

Please make checks payable to Foreign Language Network, or complete credit card information below.

Credit Card          ___Visa      ___Master Card        

Amount $__________  

Cardholder Name______________________________________________________________

Card Number__________________________________________ Exp. Date______________

Signature__________________________________________ Date _____________________


Register by Fax:  Fax form and credit card informtion to 847-594-6085.
Register by Mail:  Mail form and payment to the address above.
Register by Phone:  Call 847-426-6856.