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One-To-One Learning English Classes Pre-Registration Form
640 N. Midland Ave, Nyack, NY 10960
onetoonelearninginc@gmail.com
845-512-8176

In-Person Classes (Mon & Wed 8-9:30 PM) / Clases Presenciales (lunes y miercoles de 8 a9:30 de la noche)

ATTENTION/ATENCION

To confirm your registration, you must submit a copy/photo of your COVID vaccination proof on the first day of class.

Pare confirmar su inscription, debera entrangar una copia/foto de su comprobante de vacuna del COVID el primer dia de clase.
Name *
First Name
Last Name
Address / Direccion *
Address Line 1
Address Line 2
City
State
Zip
Telephone No. / Numero de telefono *
Email *
Country of Origen / Pais de origen *
Date of Birth *
Transportation *  
Car Van Bus Friend
License Plate (car) / Numero de placa del carro *
Relative in program *
You will attend class / Dias que asistira a clase *


Children attend? *


Name and age of Children *
Level of Education / Nivel de educacion *


All apply / Indique todos los que correspondan *



Level of English / Nivel estimado de ingles *



COVID *  
Teacher June 2024/Maestro/a Junio 2024 *