Mandarin Club Enrollment Form 2019
Please submit the completed form or leave it at the main office with Linda.
Email address *
Our mission is to create a brighter future for children. We provide opportunities for children regardless of race or families income. Our programs provide children with the tools for a successful future.
Select registration type *
Childs First Name *
Your answer
Childs Last Name *
Your answer
Child’s date of birth *
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DD
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YYYY
Childs age *
Your answer
Gender
Please select class *
Childs First Name
Your answer
Childs Last Name
Your answer
Please select class
Childs Date of Birth
MM
/
DD
/
YYYY
Childs Age
Your answer
Gender
Name of Parent/ Guardian *
Your answer
Mailing Address *
Your answer
Phone Number *
Your answer
Email
Your answer
EMERGENCY CONTACT Name/ Phone 1 *
Your answer
EMERGENCY CONTACT Name/ Phone 2 *
Your answer
Disclosure
The Mandarin Language After School Program will run every Tuesday and Thursday starting January 29th - May 23rd, 2019. There will be no class if there is early dismissal.

Hours of operation are for 3:15 – 4:15 P.M. Tuesdays and Thursdays.
Parents must pick their child up by 4:15 P.M.

Mandarin Language Club is not a babysitting service. Children are
expected to interact with other children. Children are required to participate in all activities as
instructed by staff.

Failure to follow the rules can result in your child being expelled from the After School Program.

If a child is expelled from the After School Program, there will be no refund of the membership fee.

Disrespect of the staff, refusal to follow instructions, fighting, bullying of any type, are
ground for immediate dismissal.

A registration fee of $40.00 per child per month is charged for the Mandarin Language After School Program.
There is no refund for early withdrawal from the program.
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