Young Students Registration Page | Languages in Action

Welcome to Languages in Action (L.i.a.)

Student's first name

Student's last name

Date of birth

Month

Day

Year

Mother tongue

Address

City

Zip / Postal code

Country/Region

Student Phone Number

Please, provide student's Phone number only if L.i.a. is authorized to message/call student. Communication is restricted to study materials/comments.

Parent/Guardian Details

Parent/Guardian's name

Contact email

Parent/Guardian's Phone Number:

Best way of communication with Parent/Guardian

Message

Phone Call

Email

Student's Medical waiver and release

I certify that my child is physically able to participate and that I will provide any relevant medical information. In the event of an emergency, I authorize Languages in Action to seek appropriate medical care for my child.

Check "yes" if you agree to sign the waiver. This digital agreement is as valid as a real signature on a printed form.

Yes

No (if checked, you child cannot attend classes with Languages in Action)

Allergies:

Yes

No

Please specify allergies:

Other relevant medical information

Emergency contact

Relation

Name

Phone number

Authorized Pick-up Person

Pick-up Person(s)/ Specify if Student is allowed to leave on his/her own:

Important: Should there be an exception, please email us 1. Pick-Up Person's name 2. Pick-Up Person's phone number 3. Specific Pick-up date Use the subject "PICK-UP" to call our attention, please.

Waiver and Release

I authorize my child to participate in all activities offered by Languages in Action. I understand that participation may involve certain risk of injury or illness. In consideration of my child's participation, I voluntarily assume these risks and release Languages in Action, its owners, employees, contractors, and volunteers from liability, loss, or damage arising from participation, except as prohibited by law.

Check "yes" if you agree to sign the waiver. This digital agreement is as valid as a real signature on a printed form.

Yes

No (if checked, you child cannot attend classes with Languages in Action)

Photo and Media Release

Languages in Action may take photographs and videos during class and activities. No compensation will be provided if approved images are used in print materials, website, social media, or other communications.

Please, indicate your preferences below.

I authorize L.i.a. to use photos or videos of my child in which my child is not identifiable (for example, photos of students working, hands-on activities, projects, or images taken from behind).

I authorize L.i.a. to use photos or videos in which my child's face is visible and identifiable.

Date of first class at Languages in Action.

Full name of the person completing this form

Today's Date

Payment screenshot

Please upload an image of your payment confirmation screenshot.

Young Student Registration Form