2017-2018 Registration Form 註冊單
Please submit ONE form for EACH student. Thank you! 每位學生請填寫一份註冊單
Student Information (Required) 學生基本資料
First Name 英文名字
Your answer
Last Name 英文姓氏
Your answer
Chinese Name (Please type in Chinese if you can.) 中文姓名 (請打中文)
Your answer
Date of Birth 生日
MM
/
DD
/
YYYY
Gender 性別
Language Class ($360/year + $30 Registration Fee = $390) 語言課程
Please refer to registration instruction... 請參考註冊簡章...
Textbooks or Materials Fees 課本及材料費
Multiple Student Discount 學生折扣
($30 per year per person for the third or fourth student from the same family) 同一家庭如有三位以上學生註冊第三位學生折扣 $30
Family and Parents/Guardians Information 家長或監護人基本資料
Primary Parent or Guardian Information (Required) 家長或監護人基本資料
First Name 英文名字
Your answer
Last Name 英文姓氏
Your answer
Chinese Name 中文姓名
Your answer
Please Select 請選擇
Phone 1 聯絡電話 1
Your answer
Phone 2 聯絡電話 2
Your answer
Email 電子郵件信箱
Your answer
Address 1 住址 1
Your answer
Address 2 住址 2
Your answer
City 城市
Your answer
State 州名
Your answer
ZIP Code 郵遞區號
Your answer
Occupation 家長或監護人職業
Your answer
Second Parent or Guardian Information (Optional) 第二家長或監護人基本資料
First Name 英文名字
Your answer
Last Name 英文姓氏
Your answer
Chinese Name 中文姓名
Your answer
Please Select 請選擇
Phone 1 聯絡電話 1
Your answer
Phone 2 聯絡電話 2
Your answer
Email 電子郵件信箱
Your answer
Address 1 住址 1
Your answer
Address 2 住址 2
Your answer
City 城市
Your answer
State 州名
Your answer
ZIP Code 郵遞區號
Your answer
Occupation 家長或監護人職業
Your answer
In the event we can not get a hold of the parents or guardians, please provide emergency contact person number (Required): 請提供緊急聯絡人資料,以方便我們在聯絡不到家長或監護人時可以聯絡。
Emergency Contact 緊急聯絡人
Your answer
Phone 電話
Your answer
Special Note. If your child has any allergy or other special medical situation, please inform us as soon as possible. 小孩有任何需要注意的健康狀況嗎? 如過敏等...
Health Concerns 需要注意的健康狀況
Your answer
Chinese Academy of Cleveland Waiver Statements 2017 克里夫蘭中文書院家長同意書
We/I hereby release, discharge and agree to hold harmless Chinese Academy of Cleveland, its board members and staff, as well as Shaker Heights School and its staff and all persons acting under the permission or authority, from a liability whatsoever for any and all claims of any nature which may raise out of our/my attendance at the Chinese Academy of Cleveland, and/or purchase and / or consumption of food and / or snacks offered through the Chinese Academy of Cleveland during snack time, special luncheon, and special events sponsored by the Chinese Academy of Cleveland such as Chinese New Year celebration, outdoor picnic, and end-of-year luncheon. This release covers us/me and any minor members of our/my family.
We/I hereby also agree on behalf of ourselves / myself and any minor members of our / my family to allow the staffs and board members of the Chinese Academy of Cleveland to release electronic or paper photographs of us / me and any minor members of our/ my family on published materials including newspaper articles, internet websites, and video / radio productions associated with the reporting and promotion of activities associated with the missions, actions, and activities of the Chinese Academy of Cleveland.
Furthermore, in case of emergency and my designated emergency contact cannot be reached, permission is granted to have my child treated by doctor or hospital appointed by the Chinese Academy of Cleveland or its authorized personnel.
Notes about classes and refund policy: 課堂及退費須知:
1. Classes are subject to cancellation due to low enrollment. 如果學生人數不足,課堂可能會被取消。
2. Preschool, Pre-K and Kindergarten students’ parents need to be available during class time in order to help the classroom teachers when the needs arise.
Please confirm you agree to abide by our school’s refund policies stated in the Registration Information.
CAoC Student Code of Conduct
CAoC Student Code of Conduct (A hard copy will be email to you for review. Please sign and return it after school begins.)
Required
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