长城中文学校报名表 Student Application 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 *
学生英文姓名 Last name, First name
Your answer
Chinese Name *
学生中文姓名, if student does not have Chinese name, repeat English name here
Your answer
Gender *
性别 Female, Male
Birthday *
生日 YYYY-MM-DD
Your answer
Grade *
几年级 Grade in Day school attending
Your answer
Day School *
全日制学校名 Day school currently enrolled, or fill home school
Your answer
Ethnic Group *
族别, check all that applies
Required
Chinese Classes 中文班级
Status *
新生或是升班学生或是试课
Chinese Class *
选择中文课班级 Chinese Class to enroll
Culture Class
选择文化课班级 Culture classes to enroll
Family 家庭
Must fill phone and email of at least one parent for emergency contact and getting homework and school newsletter. 必须填写至少一位家长联系电话和电子邮件,以便紧急情况下联系,并获取家庭作业和学校信息。

Contact Phone *
联系电话 For emergency contact
Your answer
Contact Email
Required for college and adult students to get homework assignments and school newsletters
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 Occupation
母亲职业
Your answer
Mother Phone
Cell Phone 联系电话
Your answer
Mother Email
Contact Email 电子邮件
Your answer
Mother WeChat ID
微信ID
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 Occupation
父亲职业
Your answer
Father Phone
contact phone
Your answer
Father Email
Contact Email 电子邮件
Your answer
Father WeChat ID
微信ID
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 newspapers, 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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service