CCT Fall 2016 Registration- Returning Student
Please fill out this form to receive a continuing student discount rate and send payment by July. 31, 2016. Classes meet every Friday: 6:30-8:30 p.m, August 26 -- December 16, 2016 (except for Thanksgiving weekend).

You may skip the information where there is no red * sign when it is the same as fall semester. However, be sure click submit to make sure the process if completed.

Tuition rate for continuing students before July. 31, 2016:
Child 1: $145 Child 2: $135 Child 3 & 4: $125 each

Tuition rate for continuing students after July. 31, 2016:
Child 1: $170 Child 2: $160 Child 3 & 4: $150 each

*Parent volunteer deposit fee: $20 per family
*The tuition fee does not include the text book fee and is not refundable after two weeks.

For example,
If you have two children studying Chinese, you will need to write a check for $300 (145 + 135 + 20) now, but $350 (170 + 160 + 20) after July 31, 2016.

Please make check payable to Chinese Center of Toledo and mail it to:
Chinese Center of Toledo, P.O.BOX 350445, Toledo, OH 43635.

***Important: You need to electronically sign the waiver before you can successfully submit the application successfully.

*The Chinese Center of Toledo admits students of any race, color and national or ethnic origin.

Student Name in Chinese: (if any)
Your answer
Gender
Birthday (Month/Year)
Your answer
Student Name in English: (Last name, First name)
If more than one child will attend the Chinese Center of Toledo, please start a new registration form for the second child and make a note at the end of this registration form about the total number of children attending the CCT.
Your answer
Name of regular school attended
Your answer
Grade level in the Fall 2016 at the regular school
Your answer
Current class at CCT or instructor's name of current class
Your answer
The year when your child started to study at the Chinese Center of Toledo
For example, Fall 2010. If your child stopped Chinese class sometime earlier but resumed the class later, you may provide two starting semesters.
Your answer
Home address:
Your answer
Home phone number:
Your answer
Father/ Legal Guardian 1 Information: name in English and/or Chinese
If you have more than one child attending CCT, you may skpe the following items where information is repeated.
Your answer
What is the Father/Legal Guardian 1's occupation?
Your answer
Father/ Legal Guardian 1 e-mail address:
Your answer
Father/ Legal Guardian 1 cell phone number:
Your answer
Mother/ Legal Guardian 2 Information: Name in English and/or Chinese
Your answer
What is the Mother/Legal Guardian 2's occupation?
Your answer
Mother/ Legal Guardian 2 Cell phone number:
Your answer
Mother/ Legal Guardian 2 e-mail address:
Your answer
EMERGENCY CONTACT/persons authorized to pick-up the child from the classroom (other than parents)
Name/relationship/phone number
Your answer
Primary language(s) used at home:
Please specify if other dialect or language is also used at home with the child.
Medical condition or other information we need to know:
Please make sure to complete this if CCT needs to be aware of any special condition.
Your answer
Do you plan to drop off your child yourself and possibly stay during the Chinese class time?
Do you have the following devices that you can let your child to use in Chinese school? (Check all that apply)
What do you expect your child to learn by the end of the semester?
You may specify different objectives for each child.
Your answer
I agree that the student may take part in all School activities. I further agree that any photographs taken of the student may be used in any way and all public relations materials. You must give written notice if you want to restrict such activities.
Type your name below to indicate your consent.
Your answer
I understand that the Chinese Center of Toledo (CCT) and CCT staff will not be held liable for student injury; or loss, damage, or theft of property while my child is in attendance at Chinese Center of Toledo's classes and activities. I understand both my child and I cannot touch, use, and remove displays and belongings in the classroom, the gym and the library at MVCDS without permission. I will assume the responsibility for repair or replacement of damages caused by my child's action.
Type your name below to indicate your consent.
Your answer
Check number
Please enter the check number for the tuition paid. Please make check payable to Chinese Center of Toledo and mail it to: Chinese Center of Toledo, P.O.BOX 350445, Toledo, OH 43635.
Your answer
Check amount
Please enter the total amount of the tuition paid.
Your answer
Note: If you have more than one child attending the CCT, please list all of their names below and enter the information of second or third child on a new form.
Your answer
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