Middlingo Registration

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Please fill out just one form for all students you are registering (i.e. if you are signing up more than one kid for any number of classes, one form will do).

For fields requiring "Name" information, please provide first and last name. Thank you!

We know that paperwork is not fun and apologize for this long form!

Email *

Student 1 - Name *

Student 1 - Date of Birth (DOB) *

YYYY

Student 2 - Name (if registering 2. child)

Student 2 - DOB

YYYY

Student 3 - Name

Student 3 - DOB

YYYY

Class/Camp Selection

Student 1

Student 2

Student 3

Week 1 Mini NiHao Jun 15 -19, 2020 $175

Week 2 Chinese for Everyone Jun 22 -26, 2020 $250

Week 3 Mini NiHao Jun 29- Jul 2, 2020 $150

Spring 2020 Class

Parent/Guardian 1 - Name *

Parent/Guardian 1 - Address *

Parent Guardian 1 - Telephone *

Parent/Guardian 2 - Name

Parent/Guardian 2 - Telephone

Emergency Contact - Name *

Emergency Contact - Telephone *

Emergency Contact - Email

Medical Release *

The children I register are up to date on their physical exam and immunizations, and are physically capable of participating in Middlingo activities. I grant Middlingo staff permission to obtain medical treatment for my child(ren) in the event of an emergency. I also agree to assume the financial responsibility for any medical treatment for my child(ren).

Required

Please list any allergies or medical concerns that we should be aware of *

Photo Release

I grant Middlingo permission to use, for publicity purposes only, any photographic or video images in which student(s) appear(s).

Payment Method *

PayPal

Check - Please make out to "Middlingo"

Required

Registration & Payment *

I understand that this registration is not confirmed until Middlingo has received payment in full for each class and each student.

Required

Confirmation

Please sign the registration below, indicating that you agree to the terms of the registration. If you are completing the form online, please type your name.

Signature

A copy of your responses will be emailed to the address you provided.

Submit

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