2020 - 2021 Afterschool Program Registration Form (Online Program)
WALNUT CHINESE LANGUAGE CENTER
20850 CARREY RD. WALNUT, CA 91789
909-594-8880
Enrollment Type *
Once on-site opens: *
Required
Student Name 姓名 (Chinese and English ) *
DOB 生日 *
Gender 性別 *
School 目前就讀學校 *
Grade 年級 on August/2020 *
If selected N/A, please state current school grade 目前就讀年級 (非1-5)
Chinese Proficiency 中文程度 *
Last completed Chinese textbook level 已讀完美洲或其他 ____ 第____冊 *
*
Native Language 母語 *
Required
Address 住址 *
Parent/Guardian Name 父母 / 監護人名字 *
Parent/Guardian's relation to the student 關係
Clear selection
Parent/Guardian's Phone Number (Home)
Parent/Guardian's Phone Number (Cell) *
Parent/Guardian's Email *
Family Doctor's Name and Telephone
Make Payment *
Required
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