Language Exchange International^®
 Au Pair Program ^© 
Application for enrollment
 

Last Name:		First Name:
Nationality:		Date of Birth:
Telephone:		E-mail address
Sponsor Name:		Address:
Program:   Exploring America - Saturdays		Number of Credits:

Start Date:

End  Date:

Course 100  (13 Colonies)  ALEXANDRIA Class is FULL OR MANASSAS Class is FULL

Course 102 (US Presidents) OR Manassas

Method of payment:       Check   #                     Cash                   Credit card 

Credit card information:  Card name

Card  #:            Expiration Date:

Amount of payment enclosed:  

Name as it appears on the card:

Signature (Au Pair):  

Signature (Sponsor) : 

How did you hear about  Language Exchange International?  

Space is reserved on a first come, first serve basis. Full payment is due at least two weeks prior to the  beginning of the course.

 Refund Policy

 If a student cancels before the course begins, all tuition less a $100 processing fee will be refunded. There are no refunds once the course begins. Classes missed are not recoverable.  

Language Exchange International is closed on the following holidays: New Years Day;  Martin Luther King Day; Presidents’ Day; Good Friday; Memorial Day; Independence Day; Labor Day; Thanksgiving (Thursday and Friday); Christmas Day

 

For more information, please write to: aupair@languageexchange.com