Huayuan Chinese Academy - Registration for 2020 Fall Semester (Ending 1/29/2021)
We welcome students at age 5 and older. 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

You may also make your payment through PayPal to HuayuanTuition@gmail.com.
(学生) 姓 Student's Last Name *
(学生) 名 Student's First Name *
Student's first name in English
(学生)中文姓名 Student's Chinese Name
Student's name in Chinese
(学生)性别 student's gender *
(学生) 出生日期 student's date of birth *
父亲姓名 (father’s Name or legal guardian's)
Firstname Lastname
父亲联系电话 (father’s or legal guardian's contact telephone number)
母亲姓名 (Mother’s Name or legal guardian's)
Firstname Lastname
母亲联系电话 (Mother’s contact phone number)
父亲联系电子邮件 (contact e-mail address) *
母亲联系电子邮件 (mother’s e-mail address)
紧急联系电话 (Emergency Contact telephone number) *
学生家庭地址 (Student's Home Address)
Street # and name, city
邮政编码 (Zip code)
家中电话 home phone number
请注明你希望哪天开始 starting date *
MM
/
DD
/
YYYY
学生英文学校年级 School grade *
学生英文学校名字 English School Name *
报名参加 Program applying for *
Required
注册费 Registration fee $30 *
Required
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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