Your Language Connection: Registration Form

Register for Classes and Camps

All required fields are marked with an asterisk (*).

Contact Information

Resgistration

Register for up to three classes/camps here. Additional classes/camps may be added in the “Other Notes” box below.

Child(ren)’s Information

If registering children, please complete the information below for up to three children.

Other Information


DISCLAIMER FOR CAMP REGISTRATIONS: By registering, I hereby give my child permission to attend Camps. I authorize the staff/volunteers of Kids and Cultures and Your Language Connection to take and use photographs and audio/video footage of my child as needed for their records and/or publicity programs. I hereby give permission for my child to be transported by Camp personnel or by ambulance for emergency treatment, as deemed necessary by Camp personnel. I accept all responsibility to carry insurance for injuries and health-related claims for my child. I hereby release Kids and Cultures, Your Language Connection, and the host location from all legal liability for my child.

Please use the submit button only once.

Make checks payable to Your Language Connection and mail to PO Box 7374 Lancaster, PA 17604.

If you prefer to mail a paper registration, please download and print this PDF.

Mailing Address & Phone

Michelle Salinas

Your Language Connection

P.O. Box 7374 Lancaster, PA 17604 United States

717-371-9144