CSCCCI Registration Form 2020 Spring

STUDENT INFORMATION

Student's English Name

Student's Chinese Name

Gender

Male Female

Birthdate

Returning Student

Yes No

Address

Class for 2019-2020

K Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Practical Chinese Culture and Language

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.

Registration Fee includes tuition, snack and activity expenses.
1st Registered Student of the family: $150.00
2nd one: $130.00, 3rd one: $125.00, 4th one: $115.00
Course Material Fee: $25.00 (only applied to new students)
Parent Duty Deposit: $30.00 (families with one registered student) and $60.00 (families with 2 or more registered students)
Online Creditcard Processing Fee: $6.00

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 2020 Spring

Description

Please Fix the Following