Information Request

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Please fill out our Children's Class request form to receive more information and a quote.
Please fill out the form below to have information sent to you via e-mail. You may also call us at 212-563-7580 and speak with a representative.
CONTACT INFO
Parent First Name:
Parent Last Name:
Child's Name:
Child's Age:
Contact Phone:
E-mail:
PROGRAM INFO
Language:

Are you interested in group or private lessons?
	Private (one child per class) Group (two or more children in the same class)
If group, how many children do you have interested in joining the group?

Student background:
	If other, please describe child's background here:
Where would you like to have your lessons?
	at ABC at my location
If your location, please give cross streets:
How many times per week would you like to have your lessons?

How did you hear about ABC Language Exchange?
	If other:

Languages

Arabic A.S.L. Cantonese Chinese/Mandarin Dutch English Farsi/Persian French German Greek Hebrew Hindi Italian Japanese Korean Polish Portuguese Russian Spanish Turkish Vietnamese Other

ABC Language Exchange 135 West 29th Street, Suite 1204, New York, NY 10001 phone: 212-563-7580 fax: 212-563-7511
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