2021-2022 Adult Chinese Program Registration Form
Start on August 21th, 2021 to May 2022
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2020-2021 Adult Chinese Program
Student Status 學生(舊生或新生) *
How do you know about this program 您如何得知該課程? *
Student's Last Name 學生的姓氏 *
Student's First Name 學生的名字 *
Student's Chinese Name
Student's Gender *
Student's Date of Birth *
Student's E-mail Address *
Language Spoken at home
Cell Phone Number *
Home Phone Number
Work Phone Number
Address 地址 *
Emergency Contact *
Emergency Contact Number 緊急聯絡電話 *
Relationship *
Allergies / Remarks
EMERGENCY AUTHORIZATION & WAIVER OF CLAIMS : I request that the above named student be permitted to participate in the Buddha’s Light Hsi Lai School (BLHLS) activities. He/She is in good physical condition, but in case of illness or accident, BLHLS has my consent to secure necessary medical attention for the above named student. I, (please print your full name),hereby release and discharge BLHLS, its directors, officers, teachers, instructors, staff members, and all other associated entities (the “Releasees”) from all claims, demands, costs, expenses, actions and causes of action, whether in law or equity, in respect to death, injury, loss or damage to the above student or his/her property however caused, arising out of the above student’s participation in activities at or related to the School, whether or not on the School’s premises. I hereby indemnify and hold each of the Releasees harmless from any and all damages, costs, losses and expenses suffered by him/her arising out of such participation and activities. CONSENT: I give my consent to Buddha’s Light Hsi Lai School to use any of the photos taken during my child/children’s participation in any of the activities of Hsi Lai School for the purpose of communicating, promoting, fundraising and, or other information about the class and the school as a whole. *
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