Stayon Language Academy Registration
Date:
First Name:
Last Name:
Age:
Date of Birth:
Mailing Address:
City:
State:
Zip Code:
Email Address:
Home Telephone Number:
Work Telephone Number:
Please indicate the term for which you want to register: Winter Spring Summer Fall
Select the class for which you wish to register If you wish to register for more than one class, you need to fill out a form for each class.
Monday, Wednesday, Friday: 8:30 AM to 10:10 AM 10:30 AM to 12:10 PM 4:30 PM to 6:10 PM 6:30 PM to 8:10 PM
Tuesday, Thursday: 8:00 AM to 10:30 AM 11:00 AM to 1:30 PM 2:00 PM to 4:30 PM
How many English classes do you plan on attending? One class Two classes Three classes More than three classes
How much English-speaking experience do you have? 0-1 year 1-2 years 2-3 years 3-4 years More than 4 years
The location where classes are held may have cats present
Do you have allergies to cats? Yes, I do and I cant be around cats Yes im allergic to cats but its ok to be around then for an hour or two No, im not allergic to cats Please write any comments or questions in the box below
Please write why you want to attend Stayton Language Academy and what your educational goals are, in the box below.
After the information on this form is processed,
you will still have some other paperwork to read and sign, before
your registration will be complete.
This may be completed when you come to your class
Remember the cost for each class is $150 for 10 weeks of class. If you wish to register for more than one class, you need to fill this form out for each class. After submitting this form, you can return to the home page or return to the registration page, if you wish to register for another class.
After registering, students are expected to pay immediately.
