2019 Summer Program Sign Up Sheet
Pacific American School
Student Information
**Please use a separate registration form for each child
Student's English Name *
Your answer
Current School *
Your answer
Current Grade *
Your answer
How many years have your child been learning English? *
Your answer
Father’s English Name
Your answer
Father’s Chinese Name *
Your answer
Father's E-mail *
Your answer
Father’s Telephone Number *
Your answer
Mother’s English Name
Your answer
Mother’s Chinese Name *
Your answer
Mother's E-mail *
Your answer
Mother’s Telephone Number *
Your answer
Address *
Your answer
Emergency Contact
In case of emergency, please notify:
Name *
Your answer
Relationship *
Your answer
Phone *
Your answer
Medical Information
Medical Information
Please list any information (i.e. allergies, disabilities, etc.) that will help us care for your child while he/she is under our supervision:
Your answer
Notes:
1. In order to finalize the application process, please pay by cash or check to our cashier within 3 days after receiving an acceptance letter from the school.
2. Fees are non-refundable.
3. PAS reserves the right to cancel any summer program session due to insufficient enrollment. In the event of cancellation, all program fees will be refunded.
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