CSCCCI Registration Form 2019 Fall

STUDENT INFORMATION

Student's English Name

Student's Chinese Name

Gender

Male Female

Birthdate

Returning Student

Yes No

Allergies

PARENTS INFORMATION

Parent1 English Full Name

Parent1 Chinese Name

Parent1 Email

This address will receive a confirmation email

Parent1 Mobile

Parent2 English Full Name

Parent2 Chinese Name

Parent2 Email

This address will receive a confirmation email

Parent2 Mobile

Emergency Contact

Emergency Contact Phone

WAIVER OF LIABILITY, HOLD HARMLESS AND PHOTO RELEASE AGREEMENT

Please review, print, sign, and return CSCCCI's Waiver of Liability, Hold Harmless and Photo Release Agreement.

(You may upload the signed CSCCCI waiver form here or physically hand in to Chinese School Office.)

Upload (8MB)

PAYMENT

Total of the payment includes Registration Fee, Course Material Fee and Parent Duty Deposit.

If you are registering for "Level 8" and "Cuture and Language", please select "Paid by Check". Thank you.

Registration Fee includes tuition, snack and activity expenses.
1st Registered Student of the family: $150.00
2nd one: $140.00, 3rd one: $135.00, 4th one: $130.00
Course Material Fee: $25.00
Parent Duty Deposit: $30.00 (families with one registered student) and $60.00 (families with 2 or more registered students)

Please note that the school will deposit the parent duty deposits to the bank. Once the parent fulfill the duty, the school will write a check to return the deposit to the parent. The parent duty deposit will not be refunded if the parent does not fulfill the duty.

Option

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

CSCCCI Registration Form 2019 Fall

Description

Please Fix the Following