Bainbridge Chinese Culture & Arts
Private Lesson Registration Form
Class Type/Fee (please select one) *
Student Information
Name of Student (First/Last) *
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Address: *
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Phone (home & mobile) *
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E-mail: *
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Emergency Contact Info
Emergency Contact (Name/Phone) *
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Family Physician (Name/Phone) *
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Thank You For Registering
Please click "Submit" button below to complete the registration.

Please notify the administrator for class arrangement and faster service.

Please contact us at or (206) 486-0826 if you have any questions.

Bainbridge Chinese Culture & Arts
P.O. Box 11681
Bainbridge Island, WA 98110
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