长城中文夏令营 Chinese Immersion Camp
Summer Camp Info


Camp Director
Jing Kang <ck@greatwallchineseacademy.org>

Student Information
Student Name *
学生英文姓名 Last name, First name
Your answer
Chinese Name *
学生中文姓名 if student does not have Chinese name, repeat English name here
Your answer
Gender *
性别 Female, Male
Birthday *
生日 yyyy-mm-dd
Your answer
Ethnic Group *
族别, check all that applies
Required
School Name *
学校 Day school currently enrolled
Your answer
Grade *
几年级 Grade in day school currently enrolled
Your answer
Camp Session *
check sessions that the student will attend
Required
Student Interests
What you want teachers know more about your student 你需要老师了解你孩子哪些信息
Your answer
Family 家庭
Street *
Your answer
City *
Your answer
Zip *
Your answer
Mother Name
母亲姓名
Your answer
Mother Phone
联系电话
Your answer
Mother Email
联系电邮
Your answer
Father Name
父亲姓名
Your answer
Father Phone
父亲电话
Your answer
Father Email
Your answer
Parent Permissions 家长许可
Medias *
I hereby consent to the use of any photographs/video tape or any media taken of my child by the school for the purpose of advertising or publicizing events, activities, facilities and programs of the school in newspapers, newsletters, website, other publications, television, radio and other communications and advertising media.
Student Work *
I authorize the school to publish my student work for the purpose of showcasing and recognizing high achievement and good examples of student learning.
Emergency *
In a medical emergency, the school has my permission to take my child to the emergency room of the nearest hospital when I cannot be contacted, and the hospital staff has my authorization to provide treatment, which a physician deems necessary for the well being of my child.
Emergency Contact Name *
Last name, First name
Your answer
Emergency Contact Phone *
xxx-xxx-xxxx
Your answer
Relationship *
How the student related to the emergency contact person
Disclaimer *
By submit the form, we/our family hereby release, waive, discharge, and forever hold harmless to Great Wall Chinese Academy, its staff, promoters, and sponsors, from any loss or damage, and any claim of damages resulting from our participation in Great Wall Chinese Academy's program on account of any injury to my person, or property, whether caused by negligence or otherwise.
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