2023 Little Dragon Summer Camp
Little Dragon Summer Camp is for K – 4th graders to learn the Chinese language and culture from June 12 – June 23, 2023 (Monday – Friday, 8: 30 am – 3:00 pm) at Northland Christian School (10500 N Arrowhead Trafficway, Kansas City, MO 64155).

The tuition is $250/week for the first child, $240/week for the second child, the third and more children in the same household, if you register before April 1, 2023. Prices go up after April 1, 2023 by $50. 

Please register one child per form and pay the tuition via Venmo @Best4Future and put down your child's name and "2023 Little Dragon Summer Camp" in the note. Please use "transfer between friends".
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Email *
Student's Name *
Student's Birthday *
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Student's Gender *
Student’s Home Address: *
Student's Home Phone *
Father or Guardian's Name *
Father or Guardian's Cellphone Number *
Mother or Guardian's Name *
Mother or Guardian's Cellphone Number
Please list any adults or relatives who are authorized to pick up the student. Please list their phone numbers as well. *
Does the student require special care? *
The student is interested in (choose one or more):
K - 2nd graders
3rd - 5th graders
Week 1 (Jun 12 – Jun 16)
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K - 2nd graders
3rd - 5th graders
Week 2 (Jun 19 – Jun 23)
Clear selection
Student's Chinese proficiency self-assessment             *
Student’s previous Chinese Lessons *
Tuition and Refund Policy
The tuition is $250/week for the first child, $240/week for the second child, the third and more children in the same household. No refunds or credits 72 hours prior to the start of the first class due to limited class size and availability.
I have read and agree with the requirement listed above in Tuition and Refund Policy *
Signature of Parent or Legal Guardian:
Emergency Medical Release Authorization
Family Doctor's Name *
Doctor Office Telephone Number *
Has your child had any serious illness, injury, operation or communicable disease since September of last year? If yes, please specify. *
Are there any conditions such as Heart Disease, Epilepsy, Diabetes, Asthma or any allergies that the school should be aware of? If yes, please specify. *
Excluding vitamins, does your child take any medication on a regular basis? If yes, please specify. *
Should your child be hurt in an accident and we are unable to contact you, please list the names of two individuals who will take responsibility in seeking medical attention: *
Should there be any changes in the above information, please inform the school immediately. If Future Education DBA Kansas City Chinese School North (“KCCSN”) is unable to contact both the students’ parents and those persons designated above, it has the authority to seek medical attention for the student with no objection from the student’s parents.

I also agree that in the event of illness or accident of my child, any Future Education DBA KCCSN officers, chaperones, teachers, volunteers, employees and other persons associated with Future Education DBA KCCSN, in whose care my child has been entrusted, is authorized to consent to an X-ray examination, anesthetic, medical or surgical diagnosis of my child; to transportation of my child to any hospital and to treatment and hospital care to be rendered to my child under the general or special supervision and upon the advice of a licensed physician and/or surgeon. I hereby indemnify, discharge and hold harmless Future Education DBA KCCSN, its officers, chaperones, teachers, volunteers, employees and other persons associated with Future Education DBA KCCSN from liability because of the exercise of such actions.

I read and agree with the requirement listed above in the Future Education DBA KCCSN medical release form.
I have read and agree with the requirement listed above in Emergency Medical Release Authorization *
Signature of Parent or Legal Guardian: *
Release of Liability and Assumption of Risk Agreement
I hereby acknowledge that I have VOLUNTARILY applied for my child to participate in any and all indoor and outdoor activities, including, but not limited to, indoor lessons and classes and outdoor exercises and field trips, under the sponsorship, organization or coordination by Future Education DBA Kansas City Chinese School North (“KCCSN”) or its officers, representatives, coordinators or trip leaders. I hereby certify that I am the adult parent or legal guardian of the participant, a minor child under the age of eighteen years, and I consent to his/her participation in 2020 Little Dragon Summer Program.

I hereby agree, personally and on behalf of the participant named above, that I, my heirs, distributes, guardians, legal representatives and assigns will defend, indemnify and save harmless, Future Education DBA KCCSN and its officers, chaperones, teachers, volunteers, employees, and other persons associated with Future Education DBA KCCSN from and against any and all claims, demands, losses, defense costs or liability of any kind or nature which Future Education DBA KCCSN, its officers, chaperones, teachers, volunteers, employees and other persons associated with KCCSN may sustain or incur or which may be imposed upon them for injury or death of persons or damage to property as a result of , arising out of, or in any manner connected with my child’s participation in any and all Future Education DBA KCCSN’s activities.

I certify that my child has the necessary skills and abilities to participate in all Future Education DBA KCCSN activities and I assume full responsibility for body injury, and loss of personal property, and expenses thereof as a result of my child’s negligence in participating in Future Education DBA KCCSN activities.  I also agree to instruct my child to abide by the rules or instructions given to them either verbally or in writing by Future Education DBA KCCSN. I further understand that Future Education DBA KCCSN reserves the right to refuse any person judged to be physically or mentally unfit to meet the rigors and requirements of participating in certain activities.


I have read and agree with the requirement listed above in Release of Liability and Assumption of Risk Agreement *
Signature of Parent or Legal Guardian: *
Media Release Authorization
I, hereby voluntarily and without compensation authorize Future Education DBA Kansas City Chinese School North (“KCCSN”), to reproduce, through audio or visual means, school activities or works related to my child(ren)'s education. My consent will enable Future Education DBA KCCSN to increase public awareness, promote continuation and improvement of educational program through promotional items including, but not limited to, brochures and posters, magazines, websites, videos, training materials, articles and stories for the news media, exhibits, etc. I have read and understand the foregoing and I consent to the use of picture and/or voice of me, my child(ren)and my other related family members as specified for the above-described purposes. I further understand that no compensation or fee will be paid for such use. I understand that this consent is voluntary and my refusal to grant such consent will have no effect on the provision of services available to me and my child(ren).
I have read and agree with the requirement listed above in Media Release Authorization *
Signature of Parent or Legal Guardian: *
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