2017 Dist428 Chinese Immersion Summer Program Registration
Eligibility: Students having completed 3rd grade through 8th grade (on first come first serve basis)

Date: June 12, 13, 14, 15, 16, 19, 20, 21, 22, 23, 26, 27, 28, 29, 30(3 weeks)
(and optional Post Learning @Aug ~ Dec.)
Time: 8:00am - 1:00pm,
Location: DeKalb High School
Fee: $70

Please make check payable to “NICLS”, 2017_Dist428 Chinese Immersion summer Camp
and mail to "1631 Sleepy Hollow Lane, DeKalb, IL 60115”

Untitled Title
Student's Name *
Your answer
Student's Chinese Name(if any, or mark N/A) *
Your answer
Date of Birth (yyyy/mm/dd) *
Your answer
Gender (M/F) *
Student's Current Grade *
(note: "3" for 3rd grade, "4" for 4th grade......)
Your answer
Student's School *
(ex: Dist428-Jeffson)
Your answer
Father’s Name *
Your answer
Mother’s Name *
Your answer
Home Phone Number[ex: (123)456-7890] *
Your answer
Parent’s E-Mail Address *
Your answer
Home - Street *
Your answer
Home - City, State, ZIP *
Your answer
Guardian's Cell Phone Number (630)123-4567 *
Your answer
Language(s) or Dialect(s) Spoken at Home *
Your answer
Parent’s Languages *
Your answer
Student's language experience *
Your answer
Class *
T-shirt size *
Submit
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