Language Instruction Registration Form Please complete the following online registration form. All information provided is private and confidential. * indicates required field Last Name:* First Name:* Occupation:* Date of Birth:* Address:* City:* Postal Code:* Email:* Phone Number:* Alternate Phone Number: Have you attended a course or workshop at Palabras before?:* No Yes How did you find out about Palabras?:* Website Online Ad (eg. Kijiji) Google Social Media (eg. Facebook, Twitter, YouTube) Friend/Family Referral Driving By TV/Radio Flyer/Magazine/Newspaper Yellow Pages Movie Theatre Onscreen Ad Other Why would you like to learn a new language? (check all that apply):* Travel Career Personal Fun Other Which language are you interested in learning?:* Spanish French Italian Portuguese ESL How much of the chosen language do you currently speak/understand?:* None A few words/phrases Basic grammar/conversation Intermediate level Advanced level For which course are you registering?:* Beginner (Small Group) Intermediate (Small Group) Advanced (Small Group) Private/Tutoring Semi-Private (2 students required) Corporate Training Children's (Small Group) Chosen Start Date:* (Please consult our course calendar) Method of Payment:* Cash Debit Cheque Visa/MasterCard Please note: Full payment must be received upon submission of this registration form in order to complete the registration process and reserve the student’s spot in the chosen course or to schedule any instruction time. Credit card payment can be processed over the phone by calling: 519-576-8839. Cash and Debit payments must be processed in person. Cheques may be mailed to: Palabras Language School, 583 Frederick St., Kitchener, ON N2B 2A8. *I understand spaces are limited and my registration is not fully processed and my space is not secured until full payment has been received.* Employer/Sponsoring Agency Name & Address (if applicable) (only if paying by company cheque or credit card) (Company credit cards subject to a 2.5% processing fee): Comments (optional): Terms & Conditions: Registration for small group courses is processed on a first-come, first-served basis, as space is limited. If the requested start date is no longer available, the student will be immediately considered for the next available start date. No refunds within 7 business days or less prior to the registered student’s start date. A $50.00 administration fee applies to registered students who cancel more than 7 business days prior to their scheduled start date. There is a $55 charge for NSF (Non-Sufficient Funds) cheque. Language instruction is non-transferable from the registered student to any other individual/student. Small group course students must complete their course during that course's specified term duration. No refunds, partial refunds, postponements, or substitutions are permitted for students who do not attend or stop attending their small group course. Private and semi-private students are required to register for a term of lessons, which must be paid in full at the time of registration, and all instruction hours must be completed within the designated term length. No refunds, partial refunds, postponements, or substitutions are permitted for students who do not attend or stop attending their private or semi-private lessons. Submission of this online registration form to Palabras Language School & Cultural Services certifies that the registrant has read, understood, and agreed to the above terms and conditions, as well as the terms of the Palabras Policy Form. The registrant certifies that the above information is true and complete.