Huayuan Chinese Academy - Registration for 2017 - 18 School Year
We welcome all students 5 years old and above. If you have any questions, please call 301-367-7074 (Yan) or 240-205-5306 (Helen). You may also e-mail us at huayuanchineseacademy2009@gmail.com.

Your payment should be made payable to Huayuan Chinese Academy and be mailed to

Huayuan Chinese Academy
PO Box # 1212
Rockville, MD 20849

(学生) 姓 Student's Last Name
Student's last name in English
Your answer
(学生) 名 Student's First Name
Student's first name in English
Your answer
(学生)中文姓名 Student's Chinese Name
Student's name in Chinese
Your answer
(学生)性别 student's gender
(学生) 出生日期 student's date of birth
Your answer
父亲姓名 (father’s Name or legal guardian's)
Firstname Lastname
Your answer
父亲联系电话 (father’s contact telephone number)
Your answer
父亲联系电子邮件 (father’s e-mail address)
Your answer
母亲姓名 (Mother’s Name or legal guardian's)
Firstname Lastname
Your answer
母亲联系电话 (Mother’s contact phone number)
Your answer
母亲联系电子邮件 (mother’s e-mail address)
Your answer
紧急联系人姓名 (Emergency Contact Name) (除父母外Other than parents)
Firstname Lastname
Your answer
紧急联系人联系电话 (Emergency Contact telephone number)
Your answer
学生家庭地址 (Student's Home Address)
Street # and name, city
Your answer
邮政编码 (Zip code)
Your answer
家中电话 home phone number
Your answer
学生英文学校年级 School grade
Your answer
学生英文学校名称 Name of regular school attending
Your answer
学生中文学校年级 Chinese School Grade
Your answer
报名参加 Program applying for
如果不是每周5天,请注明是每周的哪几天。If not the 5-day full program, which days of the week are you registering for?
注册费 Registration fee $30
付费合计 First payment total
一个月的学费再加上注册费 First month's tuition and the registration fee. Contact admin@hychinese.org for whole semester payment discount.
Your answer
Consent to Enroll
I certify that I fully understand the general rules of Huayuan Chinese Academy (HYCA) and I agree to obey the rules. In an emergency, HYCA 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 that a physician deems necessary for the well being of my child. I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, and discharge HYCA, its officers, board members, employees, representatives and agents from liability from any and all claims, including but not limited to, physical or mental injury, illness, death, and property loss arising from participation in activities of HYCA. I give permission to Huayuan Chinese Academy to use my child(ren)'s photos and movies for promotional use in classroom displays, on Huayuan's website, or on brochures and newspapers.
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