GWCA Student Family Form
Fill the form one for each student.
All information on this form is strictly confidential and for the school use only.
Student 学生
Student Name
英文姓名 Last name, First name
Your answer
Chinese Name
中文姓名, if student does not have Chinese name, repeat English name here
Your answer
Sex
性别 Female, Male
Birthday
生日 YYYY-MM-DD
Your answer
Status
新生,还是升班学生
Chinese Class
选择中文班级 Chinese Class to enroll
Culture Class
选择文化班级 Culture Class to enroll
Grade
全日制学校年级 Grade to enter in day school or home school in fall
Ethnic Group
族别
Required
Family 家庭
Home Phone
Home Phone 家庭电话
Your answer
Street
Street Address
Your answer
City
Your answer
Zip
Your answer
Mother
Last name, first name; 母亲姓名: 有中文姓名, 请填中文姓名
Your answer
Mother's Occupation
Your answer
Mother's Phone
Cell Phone 联系电话
Your answer
Mother's Email
Contact Email 电子邮件
Your answer
Father
Last name, first name; 父亲姓名: 有中文姓名, 请填中文姓名
Your answer
Father's Occupation
Your answer
Father's Phone
contact phone
Your answer
Father's Email
Contact Email 电子邮件
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 newspaper s, 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.
How you find us
Check what applies 怎样知道长城中文学校
Required
Referred By
介绍人姓名 Who referred you to our school if you are new family
Your answer
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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