Chinese School Summer

學生資料 Student Information

學生英文名字* Student English First Name

學生英文姓氏* Student English Last Name

學生中文姓名 Student Chinese Name if available (Chinese characters only)

性別* Gender

—Please choose an option—FemaleMaleOther

出生日期* Birth date

電子郵件* Email

主用電話號碼* Primary phone number

其他電話號碼 Secondary phone number

街道地址（門牌號）* Street address（apt#.)

城市* City

州* State

—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

郵政編碼* ZIP Code

緊急聯絡人士資料 Emergency Contact Information

緊急聯絡人士姓名* Name of Emergency Contact Person

緊急聯絡人士與學生的關係* Relation of Emergency Contact Person to Student *

—Please choose an option—配偶 Spouse子女 children其他親戚或朋友 Other relative or Friend

緊急聯絡電話號碼 * Emergency Contact Phone Number

Please review all information prior submitting (在提交之前，請確認所有信息都正確）)

Yes, information is accurate， Please check (是的， 所有信息都正确， 请点击）

監護人資料 Guardian Information

監護人英文名字* Guardian's English First Name

監護人英文姓氏* Guardian's English Last Name

監護人中文姓名 Guardian's Chinese name if applicable

監護人電子郵件* Guardian's Email

e.g.example@example.com

主用電話號碼* Primary phone number

其他電話號碼 Secondary phone number

街道地址（門牌號）* Street address（apt#.)

城市* City

州* State

—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

郵政編碼* ZIP Code

監護人與學生的關係* Guardian's Relation to Student

—Please choose an option—父 father母 mother其他親戚 other RelativeOther

學生英文名字* Student English First Name

學生英文姓氏* Student English Last Name

學生中文姓名 Student Chinese Name if applicable(Chinese characters only)

性別* Gender

—Please choose an option—FemaleMaleOther

出生日期* Birth date

特殊需要（例如：食物過敏等） Special Needs (e.g. allergic to some food, etc.):

緊急聯絡人士資料 Emergency Contact Information

緊急聯絡人士姓名* Name of Emergency Contact Person

緊急聯絡人士與學生的關係* Relation of Emergency Contact Person to Student *

—Please choose an option—家長 parent其他親戚 other RelativeOther

緊急聯絡電話號碼 * Emergency Contact Phone Number

Please review all information prior submitting (在提交之前，請確認所有信息都正確）)

Yes, information is accurate， Please check (是的， 所有信息都正确， 请点击）

請輸入學生的有關信息
Please input student's information

學生英文名字* Student English First Name

學生英文姓氏* Student English Last Name

出生日期* Birth date

Choose class (選擇課程）

Choose Adult Chinese Class (選擇成人中文課程）

--Choose Adult Chinese class (請選擇成人中文課)--Adult Beginner-0(成人初級中文-0)-Sat. 9:30-11:20amAdult Beginner-1(成人初級中文-1)-Sat. 9:30-11:20am

Choose Adult Culture/Leisure Class (選擇成人文化/才藝課程）

Zumba for adult 成人有氧舞蹈班-Sat. 2:00-3:00pm

Choose Youth Chinese Class (選擇青少年中文課程）

--Choose Youth Chinese class (請選擇青少年中文課)--Youth Chinese Pinyin Class (青少年暑期中文拼音班)-Sat. 9:30-11:20am

Choose Youth Culture/Leisure Class (選擇文化/才藝課程）

Piano lessons 鋼琴 (one-on-one; 50 minutes)-Sat. 9:30-12:00pm
Piano lessons 鋼琴 (one-on-one; 25 minutes)-Sat. 9:30-12:00pm

Please review all information prior submitting (在提交之前，請確認所有信息都正確）)

Yes, the information is accurate， Please check (是的， 所有信息都正确， 请点击）