Westlake Chinese Academy 2018 Chinese Language, Arts and Cooking Summer Camps Registration Form
Email address *
Full Name *
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Gender *
Age *
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School Attended *
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Name of Primary Parent *
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Home Mailing Address *
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Primary Phone *
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Secondary Phone
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Secondary Email
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Emergency Contact *
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Is student allergic to any food or medicine?
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Name of Student's Physician
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Physician's Phone Number
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Student's Insurance Carrier
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Insurance I.D. #
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Which camp(s) in Westlake will the student attend?
Which camps in Bee Cave will the student attend?
Parent Statement of Agreement: TUITION: I agree to pay the full tuition for the program to which I am registering as specified on the registration form no later than the first day of the program. I acknowledge that a $10 late fee per day passed the first day of the camp will be added to unpaid tuition balance; I acknowledge that there will be no refunds or make-up sessions due to student’s absences. For all camps, if pickup is not made by 3:35pm, an extra $20 per child per day will be charged.LIABILITY: I release Westlake Chinese Academy, its staffs and any related party - including but not limited to all facility or service providers - from any and all liability in connection with my child’s/children’s participation in any events and activities of the Westlake Chinese Academy camps. I understand and agree that my release of liability to Westlake Chinese Academy, its staffs and any related party - including but not limited to all facility or service providers - includes, without limitation, a release of all liability related to any accident to, allergic reactions of, injuries to, illness of or death of my child(ren) or any other third party (including other children or adults onsite), as well as any loss of or damage to property, while participating in any activities and camps of Westlake Chinese Academy. I further agree to reimburse Westlake Chinese Academy for any and all loss of or damage to property that my child, family members and friends may cause to the property at which the activities and programs are held. I hereby acknowledge that I have been advised and fully understand that certain elements of risks are inherent to the outdoor activities sponsored by Westlake Chinese Academy, and that my child(ren)’s participation in any program activities may entail risks of personal injury, death or damage to property. These risks include, but are not limited to: insect and animal bites and stings, any hazards presents in nature, such as (but not limited to) low lying branches, sharp or hard objects, slippery surfaces, venomous fauna and flora, or weather events such as lightning or other extreme conditions. I authorize Westlake Chinese Academy, its staffs and any related party - including but not limited to all facility or service providers - to seek and consent to emergency medical treatment for my child(ren); and to select the medical personnel, hospitals and/or clinics to treat my child/children in case of accident, illness, allergic reactions or injury while at in any of the Westlake Chinese Academy camps. I, the undersigned, remain responsible for the expense of any such medical treatment or service, and I release Westlake Chinese Academy and all related parties- including but not limited to all facility or service providers - from any and all liability of such expenses. I release Westlake Chinese Academy and it staffs and related parties- including but not limited to all facility or service providers - from any responsibility or liability for any allergic reactions of any kind or seriousness my child/children might experience while attending Westlake Chinese Academy camps. I acknowledge that, in case my child/children has/have a certain allergies, food or otherwise, I and I only, the undersigned, have the responsibility to advise him/her/them to refrain from accepting any food or item that might trigger an allergic reaction, or to use the appropriate allergy relief device/medicine according to instructions I will specify to him/her/them. In consideration of being allowed to participate in the registered program(s), I do, for myself, the child or children, my spouse, if any, and his/her/their heirs, executors, assigns and administrators, hereby release and forever discharge and agree to indemnify and hold Westlake Chinese Academy and their respective related parties, facilities where the camp is being held, directors, employees and volunteers, harmless from any and all actions, claims, demands, damages, expenses, costs and losses of any nature whatsoever, including, without limitation, court costs, expenses and attorneys’ fees, arising or alleged to have arisen on account of any injury and/or death of persons or property damage or loss and attorneys’ fees, arising or alleged to have arisen on account of any injury of persons or property damage or loss resulting from any acts or omissions of Westlake Chinese Academy and/or all related parties - including but not limited to all facility or service providers. RELEASE:Westlake Chinese Academy’s ability to successfully share its programs with new participants depends on its ability to freely use representative still or motion pictures. Consequently, as Parents/Guardians of participating child(ren), I and my child(ren) hereby give Westlake Chinese Academy the absolute right and permission to use voice recording(s), verbal statements, photograph(s) or video(s) of said child/children taken during the course of Westlake Chinese Academy sponsored activities in its promotional materials and publicity efforts. I understand that my child’s/children’s voice recording(s), ), verbal statements, photograph(s) or video(s) may be used in Westlake Chinese Academy’ s publications, print ads, direct-mail pieces, and electronic media (e.g. promotional videos and company website). I release Westlake Chinese Academy, the photographer and voice recorder, as well as their offices, employees, agents and designees from liability for any violation of any personal or proprietary rights I may have in connection with such use. Additionally, I release Westlake Chinese Academy from any monetary or other claim for the use of said voice recording(s), verbal statements, photograph(s) or video(s); and I certify that the consent and release given for the use of my child’s/children’s voice recording(s), verbal statements, photograph(s) or video(s) have been given without coercion or duress. I accept this agreement as binding upon my or my child’s/children’s heirs and/or future legal representatives, and that the voice recording(s), verbal statements, photograph(s) or video(s) may be used in the years to come without restriction. I acknowledge that Westlake Chinese Academy has no control of media use of said voice recording(s), verbal statements, photograph(s) or video(s) which are taken without permission.I have read and understand the entirety of this document. My signature below and my child(ren) attending Westlake Chinese Academy’s programs do represent my unconditional acceptance of all of its terms without exceptions. In addition, I agree to pay the full amount of the program chosen for each child. *
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Signature *
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Date *
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Where did you hear about us? *
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Do you have any question or request?
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After the submission, please complete the payment of deposit or full tuition to secure a spot in the camp(s) for your child. Please go to the following webpage to make a payment: http://westlakechineseacademy.org/payments
Promo Code (1 Per Registration):
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If you filled up the registration form in a physical copy, please mail your registration form to Yang Wang, 1813 Basin Ledge, West Lake Hills, TX 78746.
If you have any question, feel free to call 737-247-1533, or email: Yang.Wang@WestlakeChineseAcademy.org
A copy of your responses will be emailed to the address you provided.
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