Name *

First Name

Last Name

Phone

(###)

###

####

Have you studied English before? *

Yes

No

Are you a student or visiting scholar?

Yes

No

From time to time, pictures and video may be taken during English classes. We would like to be able to use these photos and videos in flyers, social media, and the church website. Names will not be posted with pictures/video unless written authorization is given by the individual. Do you give UABC consent to use photos/videos taken during English class in promotional materials?

I Do

I Do Not