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. By opting in, you agree to receive SMS messages from The Language Labs. Standard message and data rates apply. Reply STOP to opt out

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 Another 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

(Show-Hide Details)

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

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)