2016 Fall Registration Form - New Student
Welcome! Please submit a separate registration form for each child you are registering and note 10% family discounts are available.
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Child's First Name *
Last Name *
Age *
Grade completed as of June 2016
If your kid's is under 5 years old, please leave this field blank.
Language Use at Home *
Years of Learning Chinese (if any)
Please list the names of this student’s siblings that will be attending the course.
name(s)
Address *
Phone Number *
E-mail Address *
Parents'/Guardians' Names *
Other numbers where parents/guardians may be reached (work, cell, etc.):
ALTERNATIVE CONTACT - for emergency and you cannot be contacted:
Name/Relationship; Phone Number(s)
ALLERGIES: (Please write "none" if no allergies) *
MEDICATIONS (List below, with doses and times): (Please write "none" if child does not take any medication.) *
MEDICAL CONDITIONS including ADHD or any other behavioral conditions within the last 3 years. (Please write "none" if no medical conditions exist.): *
Physician name and number *
Insurance name and policy *
Permission Form *
I give my permission for the student(s) above to take part in the 2016 Fall Chinese Courses. This child, to the best of my knowledge, is in good physical condition and is capable of attending the course. I understand that indoor and outdoor activities have an inherent risk factor, and that all appropriate precautions will be taken for the safety of my child. I give my permission to the staff members, teachers, and volunteers and/or hospital staff to administer proper medical assistance to the above named participant. I agree not to hold the Fun Chinese program or any of their agents responsible in the event of injury to my child.
Signature of Parent or Guardian (Please Type) and Date *
Please check all options that apply to you: *
Required
Total *
If you already register the Chinese language class, you will receive 10% discount for the Calligraphy or Chinese Arts and Crafts class. Siblings 10% discount will be applied.  Payment is limited to one semester at a time. We only accept cash in person. Please make sure to write your student(s)' name(s) on the envelope.
Tuition Refund Policy: Prior to the beginning of the term through the second week, 100 percent of tuition can be refunded. After the end of the third week of classes, no refunds are offered.
Classroom Location: 6720 N Capital of Texas Hwy, Austin, TX 78731
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