Language ________________   Session:    ___ FALL '08    ___ SPRING '09

Class Day(s) and Time(s) ______________________________________________

Child's Name _____________________________  Age _____   D.O.B. __________

Street Address __________________________ City & Zip__________________

Parent Name(s) _____________________ Email __________________________

Home Phone____________________ Work or Cell Phone_____________________

Other Emergency Contact _____________________ Phone ___________________

Register by Fax:     Fax form with credit card payment to 847-594-6085.
Register by Mail:    Mail form with check or credit card payment to the address above.
Register by Phone:  Call us at 847-426-6856.

Please make checks payable to Foreign Language Network.

AutoPay  Tuition is divided into equal monthly installments and includes a $2 per month service fee.  Must be paid via credit card only.  The first payment will be charged on or
just prior to the start of classes, and subsequent payments will be automatically charged to your credit card on the first of each month.

Credit Card     ___Visa    ___ MasterCard

Total Amount $____________     or $_________ per month via AutoPay