Orlando Chinese Church - Chinese School (Mandarin/Cantonese) Registration Form 奧蘭多中華教會 - 中文學校(普通話/廣東話)報名表
Orlando Chinese Church 奧蘭多中華教會
2230 Rouse Rd.
Orlando, FL 32817
407-442-9388
http://www.orlandochinesechurch.org
Select the class you are registering for: 請選擇註冊的班級: *
Student Name 學生姓名 *
Your answer
Birthday 出生日期 (mm/dd/yyyy) *
Your answer
School Grade 學校年級 *
Address 地址 (include city, state, and zip code) *
Your answer
Telephone 電話 (xxx-xxx-xxxx) *
Your answer
Parent's Name 家長姓名 *
Your answer
Email Address 電子郵件地址 *
Your answer
Language Spoken At Home 家中常用語言 *
Your answer
Last Chinese Class Level 已達到最高的中文班程度
Your answer
In the event of illness or accident and unable to contact above, please contact 如果疾病或意外發生後,未能聯絡上列家長,請聯絡:
Emergency contact 緊急事故聯絡人 *
Your answer
Relationship 聯絡人關係 *
Your answer
Contact Address 聯絡人地址 (include city, state, and zip code) *
Your answer
Contact Phone 聯絡人電話 (xxx-xxx-xxxx) *
Your answer
Waiver And Medical Authorization
The parents consent to the language instruction giving to the child at the Orlando Chinese Church, and release the church of any legal responsibilities of accident, injury and other things happen to the child. 家長同意讓孩子接受奧蘭多中華教會的語言教學;並且同意如果孩子在教會場所有任何意外、受傷、或是未知的情況發生,教會不必負任何法律責任。
Parent's Signature 家長簽名 (Acknowledgement 確認 - By typing my name, it is the same as a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. 下面輸入我的名字,等同一個法定簽名,確認我承認並同意上述接受條款) *
Your answer
Date 日期 (mm/dd/yyyy) *
Your answer
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