Clone of Quarterly Class Registration Form

1
Parent Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Phone Number* This field is required.
Phone number should be of form xxx-xxx-xxxx
4
How Many Children Do You Want To Enroll?* This field is required.
Please Select
Please Select
1
2
3
4
5
Child 1 Full Name* This field is required.
First Name
Last Name
6
Which Year Was This Child Born?* This field is required.
Please Select
Please Select
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
7
Which Language Do You Want This Child To Learn?* This field is required.
Please Select
Please Select
Twi
Fante
Ga
Ewe
8
Which 2 Days Do You Want Your Child To have The Lesson? (Monday/Tuesday and Wednesday/Thursday)* This field is required.2 days a week spaced out
Monday
Tuesday
Wednesday
Thursday
9
Which Time Do You Choose (EST)?* This field is required.
Please Select
Please Select
5-6PM
6-7PM
7-8PM
8-9PM
10
Child 2 Full Name
First Name
Last Name
11
Which Year Was This Child Born?
Please Select
Please Select
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
12
Which Language Do You Want This Child To Learn?
Please Select
Please Select
Twi
Fante
Ga
Ewe
13
Which 2 Days Do You Want Your Child To have The Lesson?(Monday/Tuesday and Wednesday/Thursday)Choose 2 days spaced out
Monday
Tuesday
Wednesday
Thursday
14
Which Time Do You Choose (EST)?
Please Select
Please Select
5-6PM
6-7PM
7-8PM
8-9PM
15
Child 3 Full Name
First Name
Last Name
16
Which Year Was Child 3 Born?
Please Select
Please Select
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
17
Which Language Do You Want This Child To Learn?
Please Select
Please Select
Twi
Fante
Ga
Ewe
18
Which 2 Days Do You Want Your Child To have The Lesson?(Monday/Tuesday and Wednesday/Thursday)
Monday
Tuesday
Wednesday
Thursday
19
Which Time Do You Choose (EST)?
Please Select
Please Select
5-6PM
6-7PM
7-8PM
8-9PM
20
Child 4 Full Name
First Name
Last Name
21
Which Year Was This Child Born?
Please Select
Please Select
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
22
Which Language Do You Want This Child To Learn?
Please Select
Please Select
Twi
Fante
Ga
Ewe
23
Which 2 Days Do You Want Your Child To have The Lesson?(Monday/Tuesday and Wednesday/Thursday)
Monday
Tuesday
Wednesday
Thursday
24
Which Time Do You Choose (EST)?
Please Select
Please Select
5-6PM
6-7PM
7-8PM
8-9PM
25
Monthly Payments* This field is required.Choose the number of children you plan to enroll this quarter
prevnext( X )
1 Child - Afrilingua Monthly Payment
This covers monthly as your children grow in their Ghanaian language fluency
$96.00 for each month
SUBSCRIBE
2 Children - Afrilingua Monthly Payment
$182.00 for each month
SUBSCRIBE
3 Children - Afrilingua Monthly Payment
$269.00 for each month
SUBSCRIBE
4 Children - Afrilingua Monthly Payment
$355.00 for each month
SUBSCRIBE
Email
First Name
Last Name
Should be Empty: