Young Reader Class Registration
This class is designed to help promote and develop reading skills in young children (age 4 and up). An enrollment fewer than 4 students will be considered low enrollment.

Location: 1806 Zach Russell Dr., Cedar Park, TX 78613
Time: Wednesday 3:30-5:30 pm

* You will have to complete a registration form for each student. If you have questions, please contact us
at 512-900-1898
or CoolongChinese@gmail.com

* After submitting your form(s), you will receive an email with a summary of your enrollment information and payment instruction. Be sure to check the information, if there is any error, please contact us for corrections.

* Registration fee: $50 for new student/$25 for returning student
* Class fee: $115/month includes all handouts and craft materials
* Sibling and referral discounts available.
* Books: Si Wu Kuai Du (四五快读) sold on Amazon (https://www.amazon.com/gp/product/B018KXJF54/ref=ox_sc_act_title_1?smid=A1SOUZ5O2BUNNL&psc=1)
* Lesson schedule: 3:30-4:10 Review and lesson
4:10-4:20 Break
4:20-5 Lesson and practice (rhymes/stories/songs)
5-5:30 Classwork/Hands-on activities
Fall 2019 *
Required
Student Info:
First Name *
Your answer
Last Name *
Your answer
Grade *
Gender *
Home Address *
Your answer
School Attending *
Your answer
Language(s) Spoken at Home *
Required
Enrolled Sibling(s)
Your answer
Please list any existing allergies, medical conditions, medication and /or special attention your child may require:
Your answer
Parent/Guardian Info:
Name *
Your answer
Relation to student *
Your answer
Phone *
Your answer
Email *
Your answer
How did you hear about our program? *
Required
Referred by (student's name)
Your answer
Emergency Contacts Info:
Contact #1 Name *
Your answer
Phone *
Your answer
Relation to Student *
Your answer
Contact #2 Name
Your answer
Phone
Your answer
Relation to Student
Your answer
Coolong Chinese Media and Liability Release
I give Coolong Chinese the right to use photographs or videos of myself and/or the enrolled individual(s) in the production of web sites, film or sound track recordings, and any other forms of promotional/educational materials. I waive all rights to inspect or approve the final version of the photos or videos.

I release and discharge Coolong Chinese, its staff, officials and volunteers from any or all claims of injury or damages from any accident or illness may be sustained by myself or the enrolled individual(s) while participating in activities at any location, whether caused by the negligence of Coolong Chinese or otherwise. If medical attention is required, I give my permission for such medical care. I agree to hold harmless and indemnify the above mentioned parties and/or representatives against any loss, damages, or cost of whatsoever nature including expenditure of attorneys’ fees which may be suffered as a result of any action, claim, or demand by my child or my child’s heirs, by me, my heirs, successors or assigns, or by any other person on his/her own behalf or for the benefit of the child.
Privacy Policy
Coolong Chinese will only collect and store personal information for communication and promotion. Collected information will not be used or shared with any third party.
Fees and Payment Guidelines
Registration fee: $50 for new student/$25 for returning student
Class fee: $115/month includes all handouts and crafting materials
Sibling discounts: $5 off for each additional siblings after the first registered student
Referral discounts: For new students only, if referred by a registered student, both students will get a $10 reward applied to the next month.

We accept personal check and cash. Please make your check payable to "Coolong Chinese".

Monthly class fee is due on the 1st day of each month. Payment will be considered late on the 5th day of the month. A $35 charge will be assessed for returned checks. Coolong Chinese reserves the right to require payment by cash or certified funds.

Cancellation and Refund Policy
If you need to cancel your registration, please contact us at CoolongChinese@gmail.com. The following policies and timeline apply.

* Registration fee is non refundable if class is open as scheduled.
* 100% class fee refund when class is cancelled due to low enrollment or when written notification is received prior to one week before class begins.
* 70% refund when written notification is received within one week before class begins.
* Refunds are not issued if notice of cancellation is received after the class begins.
* Fees are not prorated for missed classes. Students with disruptive behavior may be removed from class with no refund.
* If a student has a condition or sustains an injury that results in the inability to participate in class, a doctor's statement, including the reason the child is unable to participate is required. A partial refund may be processed:
- Before 3rd class 50% refund
- No refunds after 3rd class.
By submitting the registration, I acknowledge that I have read and accepted the Coolong Chinese Media and Liability Release and Fees and Payment Guidelines. I acknowledge that I have read the Privacy and Refund Policy and fully understand its terms. I also acknowledge that I have the authorization to act on behalf of enrolled students. I understand that clicking SUBMIT below is the equivalent of my signature and demonstrates acceptance of the above terms in their entirety.
*
Required
*
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy