Fall 2017 Chinese School Registration
Student Chinese Name
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English Name
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Gender
Date of Birth
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Current Medications
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Medicines or Food Allergies
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Father's Name
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Mother's Name
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Home Address
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City
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Home Phone
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Parent Cell Phone
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Emergency Phone #
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Email Address
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Parent Release and Agreement: I give my permission for my child(ren) listed above to attend the Chinese School. I authorize my child to receive emergency medical treatment provided by a staff member of the Chinese School, the First Chinese Baptist Church of San Antonio, or a medical facility. In case of such emergency medical treatment provided, I agree to be responsible for all actual fees and costs incurred. I agree to release the Chinese School, its staff members, and the First Chinese Baptist Church of San Antonio from any legal and/or financial liabilities if my child suffers bodily injuries while on the premises of the Chinese School or the Church. I will help to maintain order and safety of all students and take full responsibility if the above mentioned student caused any damage to school property. If the above mentioned student withdraws from school during the first two weeks of semester, school will refund 70% of the tuition. No refund after two weeks. If the student will be absent from a class, please notify the teacher.
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