Enrollment

Your Name*

Your Email*

Student Registration

The following is the registration form. The prompts below pertain to the student that is being enrolled.

Term*

First Name*

Last Name*

Chinese Name

Sex*

Birthday*

Native Language*:
If other, state the language:

Chinese Proficiency (if known)

Class: Chinese (Traditional) Book: Chinese (Simplified) Book:

Address*

Name of English School

Grade Level*:

First Parent or Guardian

First Name*:
Last Name*:
Chinese Name:
Relation:
Home Phone:
Cell Phone:
Work Phone:

Second Parent or Guardian

First Name:
Last Name:
Chinese Name:
Relation:
Home Phone:
Cell Phone:
Work Phone:

Emergency Contact

Name*:
Relation*:
Home Phone:
Cell Phone:
Work Phone:

Family Doctor

Name:
Address:
Phone:

AUTHORIZATION FOR EMERGENCY MEDICAL CARE AND CLAIM WAIVER:
I HEREBY ACKNOWLEDGE MY CHILD’S ENROLLMENT IN AMERICAN CHINESE SCHOOL (ACS) AND I GRANT MY PERMISSION FOR MY CHILD TO
PARTICIPATE IN ALL ACS ACTIVITIES. I HEREBY AUTHORIZE THE EMPLOYEES OF AMERICAN CHINESE SCHOOL TO ADMINISTER GENERAL FIRST
AID TREATMENT FOR ANY MINOR INJURIES OR ILLNESSES EXPERIENCED BY MY CHILD. IF THE INJURY OR ILLNESS IS IN NEED OF EMERGENCY
TREATMENT, I AUTHORIZE ACS TO SUMMON ANY AND ALL PROFESSIONAL EMERGENCY PERSONNEL TO ATTEND, TRANSPORT, AND TREAT THE
CHILD. I AGREE TO ASSUME FINANCIAL RESPONSIBILITY FOR ALL EXPENSES OF SUCH CARE. I AM HEREBY WAIVING ALL CLAIMS AGAINST ACS
AND/OR ROWLAND UNIFIED SCHOOL DISTRICT FOR ANY ILLNESSES, ACCIDENTS, INJURIES OR DEATH.

Refund Procedure:

All refunds will be deducted $50 dollars registration fee. Further refund conditions are as follows:

Full refunds before classes begin; half refunds within the first week of classes; no refunds after the second week of classes.

I have read and approved the above statement.

Additional Message or Notes

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