CSCCCI 2021 Summer Camp Registration Form

STUDENT INFORMATION

Student's English Name

Student's Chinese Name

Address

Gender

Male Female

Date of Birth

Returning Student

Yes No

Allergies

PARENTS INFORMATION

Parent1 English Full Name

Parent1 Email

This address will receive a confirmation email

Parent1 Mobile

Parent2 English Full Name

Parent2 Email

This address will receive a confirmation email

Parent2 Mobile

Emergency Contact Name

Emergency Contact Number

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

Registration Fee: $55.00
Material Fee: $15.00

Option

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Dates: July 26-30, 2021, Monday - Friday 1-4 PM.

A Dip into Summer: Learning Mandarin through Chinese Poetry and Arts