Application Form: Full Immersion Chinese Camp/Volunteering in China
July 08 - 26, Taizhou, China
Applicant must be 14 yrs old and up by July 01, 2019.
Email address *
Full Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
First Language
Your answer
Second Language
Your answer
Primary Phone *
Your answer
Secondary Phone
Your answer
Home Mailing Address *
Your answer
School Attended (If you are a student)
Your answer
Name of Primary Parent (If you are under 18 yrs old) and his/her phone number
Your answer
Emergency Contact 1 *
Your answer
Emergency Contact 2
Your answer
Do you have any teaching experience? If yes, please briefly tell us about your experience. (Teaching experience is not required.) *
Your answer
Do you have any teaching certification? If yes, what is it? *
Your answer
Have you learnt Chinese? *
How do you learn Chinese?
How long have you been learning Chinese?
Your answer
Chinese Language Proficiency
Have you been to China before? *
If you answered yes to the last question, how long did you stay in China last time?
Your answer
Are you currently receiving medical treatment? *
If you answered yes to last question, please explain
Your answer
Are you allergic to any food or medicine? *
Your answer
Do you have any type of special diet that we should know about for medical or religious reasons? *
Your answer
Your Insurance Carrier
Your answer
Insurance I.D. #
Your answer
How many children will you bring? (If you are a parent, we cover expense of one dependent per parent. The cost of any extra dependent is $700 per person )
Full Immersion Chinese Camp *
Full Immersion Chinese Camp for Your Child(ren) (If you bring any with you) *
How many weeks would you like to volunteer in our program?
Do you have any other question or request?
Your answer
Declaration of Applicant: *
Required
Electronic Signature of Applicant *
Your answer
Date of Today *
MM
/
DD
/
YYYY
How do you know about our program? *
Your answer
If you have any question, feel free to call 737-247-1533, or email: intensive.mandarin.class@gmail.com
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service