Children’s Italian Language Classes, 2024 – 2025 – Elmwood Park Tuition Form Elmwood Park Recreation CenterParent/Guardian InformationFirst Name *Last Name *Relationship *Email Address *Phone Number *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Emergency Contact InformationContact 1: First & Last Name *Contact 1: Relationship *Contact 1: Cell Phone *Contact 1: Email Address *Student InformationNumber of Students *OneTwoThreeFourStudent 1Student 1: First Name *Student 1: Last Name *Student 1: Class Level *Choose One:Exploratory | $500Beginning 1 only | $675Beginning 2, 3 | $675Student 1: Date of Birth *Student 1: Years in Italian *Student 1: Current Grade *Student 1: Allergies and Medical ConditionsDoes {name-5} (Student 1) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.Student 1: Allergies *YesNoStudent 1: Allergy Description0 / 180Student 1: Medical Issue? *YesNoStudent 1: Medical Condition Info.0 / 180Student 1: Message0 / 180Student 2Student 2: First Name *Student 2: Last Name *Student 2: Class Level *Choose One:Exploratory | $500Beginning 1 only | $675Beginning 2, 3 | $675Student 2: Date of Birth *Student 2: Years in Italian *Student 2: Current Grade *Student 2: Allergies and Medical ConditionsDoes {name-9} (Student 2) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.Student 2: Allergies *YesNoStudent 2: Allergy Description0 / 180Student 2: Medical Issue? *YesNoStudent 2: Medical Condition List0 / 180Student 2: Notes0 / 180Student 3Student 3: First Name *Student 3: Last Name *Student 3: Class Level *Choose One:Exploratory | $500Beginning 1 only | $675Beginning 2, 3 | $675Student 3: Date of Birth *Student 3: Years in Italian *Student 3: Current Grade *Student 3: Allergies and Medical ConditionsDoes {name-13} (Student 3) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.Student 3: Allergies *YesNoStudent 3: Allergy Description0 / 180Student 3: Medical Issue? *YesNoStudent 3: Medical Condition List0 / 180Student 3: Notes0 / 180Student 4Student 4: First Name *Student 4: Last Name *Student 4: Class Level *Choose One:Exploratory | $500Beginning 1 ONLY | $675Beginning 2, 3 | $675Student 4: Date of Birth *Student 4: Years in Italian *Student 4: Current Grade *Student 4: Allergies and Medical ConditionsDoes {name-8} (Student 4) have any allergies or any medical issues Casa Italia needs to be aware of? If yes, please list allergies and /or medical issues.Student 4: Allergies *YesNoStudent 4: Allergy Description0 / 180Student 4: Medical Issue? *YesNoStudent 4: Medical Condition List0 / 180Student 4: Message0 / 180PHOTOS: If any photos are taken of your child(ren) participating in our Italian language program, do you allow Casa Italia, Inc, DBA Italian Cultural Center, to use photos for promotional reasons? * I Allow Casa Italia To Take Pictures Of My Child(ren) For Promotional Reasons.NoRefund Policy: Refunds for classes are based on specific dates of withdrawal. 1. A full tuition refund of 100% will be given if a student withdraws before the first scheduled class. A partial refund of 80% will be given if a student withdraws between the first and second scheduled classes. NO refunds will be given after the second scheduled class. 2. Textbooks for children’s and adults classes are not sold by Casa Italia and are not returnable or refundable. 3. Any applicable tuition discounts will not be given at the time of registration. They will be applied retroactively once the tuition payment has been received.. To cancel or change the registration, you may call 708-345-5933 or email your request to info@casaitaliachicago.org. *I have read and understand the Cancellation Policy. If you have questions call 708-345-5933.How did you find out about our Italian Language Program?Fra NoiCasa Italia WebsiteCasa Italia Constant Contact EmailCasa Italia FacebookNewspaper AdWord of MouthOtherTOTALPayment MethodCredit Card / Debit Card / PayPalCheck by Mail - Casa Italia, 3800 W. Division St., Stone Park, IL 60165Submit Form