CCT Spring 2017 Registration-New Student-b
Please fill out this form to register.
Classes meet every Friday: 6:30-8:30 p.m, January 20 -- May 19, 2017 (except for Chinese New Year and MVCDS Spring Break).

Tuition rate for new students after January 1, 2017:
Child 1: $170; Child 2: $160; Child 3 & 4: $150 each

*A one-time non-refundable registration fee of $20 will be charged for each new student family.

**Parent volunteer deposit fee: $20 per family (The fee will be returned to parents or roll into next semester when the service is completed.)

For example, if you have one child in the family, please write a check of $210 after January. 1, 2017.

***The tuition fee does not include the text book fee and is not refundable after two weeks of the instruction.

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 English: (Last name, first name)
Fill the name in the box below. 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 CCT in your family.
Your answer
Student Name in Chinese: (if any)
Fill the name in the box below. If more than one child will attend the Chinese Center of Toledo, please start a new entry and make a note at the end of the registration form.
Your answer
Birthday (month/year)
Your answer
Gender
Name of regular school attended
Your answer
Grade level in the Fall 2016 at the regular school
Your answer
Even if you are not CCT student in the spring semester of 2017, have you attended CCT before? If yes, when?
Your answer
Home address:
Your answer
Home phone number:
Your answer
Father/ Legal Guardian 1 Information: name in English and/or Chinese
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 e-mail address:
Your answer
Mother/ Legal Guardian 2 cell phone number:
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.
Your answer
Check number
Please enter the check number for the tuition paid. Please make check payable to the 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. Tuition rate for new students after January 1, 2017: Child 1: $170; Child 2: $160; Child 3 & 4: $150 each *A one-time non-refundable registration fee of $20 will be charged for each new student family. **Parent volunteer deposit fee: $20 per family. (The volunteer deposit will be returned to parents if service is completed or be rolled over to the next semester after service is completed.) (In this case, if you have one child, please write a check of $210 after January 1, 2017.)
Your answer
Thank you! 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.
If you have any question or concern, please send an e-mail to toledochineseschool@gmail.com.
Your answer
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