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.
NOTE: IF YOU ARE REGISTERING LESS THAN TWO WEEKS BEFORE START DATE, PLEASE CALL US AT 847-426-6856 OR SEND EMAIL TO: flnrobin@comcast.netPlease make checks payable to Foreign Language Network, or complete credit card information below.