2021-2022 Adult Chinese Program Registration Form
Start on August 21th, 2021 to May 2022
Sign in to Google to save your progress. Learn more
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? *
Required
Student's Last Name 學生的姓氏 *
Student's First Name 學生的名字 *
Student's Chinese Name
學生中文名字
Student's Gender *
學生的性別
Student's Date of Birth *
學生的出生日期
MM
/
DD
/
YYYY
Student's E-mail Address *
Language Spoken at home
在家所講的語言
Cell Phone Number *
手機號碼
Home Phone Number
家庭電話號碼
Work Phone Number
公司電話號碼
Address 地址 *
Emergency Contact *
緊急聯絡人
Emergency Contact Number 緊急聯絡電話 *
Relationship *
與學生的關係
Allergies / Remarks
過敏/特別注意事項
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. *
Required
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of blhls.org. Report Abuse