The Language Labs Online Registration

Registration

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Welcome! THE FORM BELOW MUST BE FULLY COMPLETED, AND ACCOUNT CREATED, TO SECURE YOUR REGISTRATION. •••• TO PAY ONLINE: At the bottom of the registration form, you will enter in your credit/debit card. Once completed, we will process your payment. You will receive 2 emails: 1) Confirming your class registration 2) Confirming that your card has been processed. For mail send to: PO Box 218 5707 South Cass Ave Westmont IL 60559

* denotes required fields

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Contact #1

Emergency Contact First Name*

Last Name *

How Can We Contact You?

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade*

Homeroom Teacher*

Allergies?*

Bus/Car Line/Walker?*

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade*

Homeroom Teacher*

Allergies?*

Bus/Car Line/Walker?*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade*

Homeroom Teacher*

Allergies?*

Bus/Car Line/Walker?*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade*

Homeroom Teacher*

Allergies?*

Bus/Car Line/Walker?*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade*

Homeroom Teacher*

Allergies?*

Bus/Car Line/Walker?*

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

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I Agree to All of the Above

Questions or Concerns

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Credit Card

Required Policies

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