Student Volunteer Application Form

For students who are interested in earning Student Service Learning (SSL) credit. Please fill in the following form and also send your statement of interest, resume and the recent two years' transcript to huayuanchineseacademy2009@gmail.com.

Student Name

Please put in this order: Last Name, First Name

Your English School Name

Grade *

Gender *

Female

Male

Phone Number

e-mail

Volunteer School

Start Date

End Date

Prefered time of the week and day

Emergency Contact Phone Number *

Father Name

Father or Legal Guardian Phone Number

Mother Name

Mother or Legal Guardian Phone Number

Parent or Legal Guardian e-mail

Home address

Consent to Apply (by the applicant's legal guardian)

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.

Yes

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