2018 Dist428 Chinese Summer Camp Registration
Eligibility: Students having completed 3rd grade through 8th grade (on first come first serve basis)

Date: June 11, 12, 13, 14, 15 ( 1 week 5 days )
Time: 8:00am - 12:00pm,
Location: DeKalb High School
Fee: $50

Please make check payable to “NICLS”, 2017_Dist428 Chinese summer Camp
and mail to "1631 Sleepy Hollow Lane, DeKalb, IL 60115”

Student's Name *
Your answer
Student's Chinese Name(if any, or mark N/A) *
Your answer
Date of Birth (yyyy/mm/dd) *
Your answer
Gender (M/F) *
Student's Current Grade *
(note: "3" for 3rd grade, "4" for 4th grade......)
Your answer
Student's School *
(ex: Dist428-Jeffson)
Your answer
Father’s Name *
Your answer
Mother’s Name *
Your answer
Guardian's Phone Number[ex: (123)456-7890] *
Your answer
Guardian's E-Mail Address *
Your answer
Guardian's Address *
Your answer
Guardian's Emergency contact Number (630)123-4567 *
Your answer
Language(s) or Dialect(s) Spoken at Home *
Your answer
Parent’s Languages *
Your answer
Student's language experience *
Your answer
Camp experiences *
T-shirt size *
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