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 *
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.
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