Adult Registration Form

Referred By (if applicable):

Please choose class option:

days
Wednesday at 6:00 - 8:00 pm Saturday at 2:15 - 4:14 pm Private tutoring

Fees Payment Plan

Classroom course: $236.00 + GST payable at time of registration, for an 8 weeks program ($14.75 per hour).

Private Tutoring: $400.00 + GST payable at time of registration, for 16 hours of private instruction. The classes can be taken in a maximum period of 3 months on a prearranged schedule. Each class is 2 hours. Any hours left after the 3 months period elapses are forfeited.

STUDENT INFORMATION:

Full Name:

Home Address:

Number/ Street / City/ Province / Postal Code

Date Of Birth (Month/ Day/ Year)

Gender

Email

Phone

Language(s) spoken & proficiency level (basic-intermediate-fluent):

Occupation (optional)

EMERGENCY CONTACT INFORMATION

Name:

Relationship:

Phone:

Address

* Class switches are subject to availability

WITHDRAWAL

30 day's written notice prior to the first day of the program is required to withdraw from
Fairouz Academy programs and have the appropriate fees cancelled. 15% of fees are non-
refundable.

We will NOT provide refunds after the start of the program or if registration is
cancelled less than 30 days prior to the start of the program, and no prorating of fees
will be provided.

Release of Liability

Release

I hereby consent to the above terms, and hereby recognizes and acknowledges that Fairouz Arabic Language Academy LTD and staff will not be responsible for personal injury or loss. I hereby consent to Fairouz Arabic Language Academy LTD calling an ambulance if deemed necessary. It is my responsibility for any costs incurred.

Photo Release

PhotoRelease

I hereby authorize my photo to appear in the media or to be used to promote or publicize our programs without compensation. My name and identity will not be revealed. Should I prefer that Fairouz Arabic Language Academy LTD do not photograph me I will notify Fairouz Arabic Language Academy LTD via e-mail at info@fairouzacademy.org.