German Heritage Language School Association of Nova Scotia
Adult Registration




     German Heritage Language School
     5873 Inglis Street
     Halifax, NS  B3H 1K7



     Term :   ________________________________

     Level :   Beginner        Intermediate     Advanced    ( $ 110.00 )

     Book :   Passwort          1       2       3       4        ( $  50.00 )

     Fee  :    ________________________________


     Name :     _____________________________________________________________

     Address : _____________________________________________________________

     City :        ___________________________________    Postal code :  ____________

     Phone :    home  ___________________________    work   _____________________

     Email :     _____________________________________________________________


     Waiver :  I expressly release the German Heritage Language School Association of NS,
                   its Board of Directors and its teachers from any and all liability arising from or
                   incidental to the student's participatioin in any of the events, programs, or
                   activities of the German Heritage Language School.




     Date :   _______________               Signature :   _____________________________