Fall 2017 Chinese School Registration
Student Chinese Name *
Your answer
English Name *
Your answer
Gender *
Date of Birth *
Your answer
Current Medications *
Your answer
Medicines or Food Allergies *
Your answer
Father's Name *
Your answer
Mother's Name *
Your answer
Home Address *
Your answer
City *
Your answer
Home Phone *
Your answer
Parent Cell Phone *
Your answer
Emergency Phone # *
Your answer
Email Address *
Your answer
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. *
Required
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms