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.net

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.