密西根中文學校 Register MCS Februrary 2016 – June 2016 Classes

密西根中文學校 February 2016 - June 2016 Registration Form ( Whole Family )

1. Please fill the online registration form. The first day of school is 2/06/2016.

2. Only current enrolled students pre-register by 1/23/2016 can waive the registration fee USD 20.

3. Pay to Cashier at school on 1/16/2016, 1/23/2016, or 2/06/2016. Check or cash only. Payment received after 2/06/2016 will need to include the USD 20 registration fee regardless your registration is done by 1/23/2016.
Or
Make check payable to Michigan Chinese School with the student(s)' name(s) on it, and mail ( Post Date needs to on or before 2/06/2016 to waive the USD 20 registration fee ) the check to:
Michigan Chinese School
40000 Six Mile Rd.
Northville, MI 48168

4. If you have any questions, please contact us by: michigan_chinese_school@yahoo.com

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1. Student Information (for MCS family directory):

Student1 Last Name *

Student1 First Name *

Student1 Chinese Name

Student1 Birth Date ( MM/DD/YYYY ) *

Student1 Gender *

Student1 American School Grade (new semester) *

Student1 Regular/CFL Class (new semester) - Note: Michigan Chinese School may adjust student's class to meet student's readiness and learning preference *

Student2 Last Name

Student2 First Name

Student2 Chinese Name

Student2 Birth Date ( MM/DD/YYYY )

Student2 Gender

Student2 American School Grade (new semester)

Student2 Regular/CFL Class (new semester) - Note: Michigan Chinese School may adjust student's class to meet student's readiness and learning preference

Student3 Last Name

Student3 First Name

Student3 Chinese Name

Student3 Birth Date ( MM/DD/YYYY )

Student3 Gender

Student3 American School Grade (new semester)

Student3 Regular/CFL Class (new semester) - Note: Michigan Chinese School may adjust student's class to meet student's readiness and learning preference

Student4 Last Name

Student4 First Name

Student4 Chinese Name

Student4 Birth Date ( MM/DD/YYYY )

Student4 Gender

Student4 American School Grade (new semester)

Student4 Regular/CFL Class (new semester) - Note: Michigan Chinese School may adjust student's class to meet student's readiness and learning preference

2. Family Information (for MCS family directory):

Father Last Name

Father First Name

Father Chinese Name

Father Office Phone

Father Phone ( Cell )

Father Email

Mother Last Name

Mother First Name

Mother Chinese Name

Mother Office Phone

Mother Phone ( Cell )

Mother Email

Emergency Contact Last Name

Emergency Contact First Name

Emergency Contact Chinese Name

Emergency Contact Office Phone

Emergency Contact Phone ( Cell )

Emergency Contact Email

3. Home Information (for MCS family directory):

Home address: Street *

City *

Zip *

Major phone for contact *

Email Address *

4. Medical Information:

Physician Last Name *

Physician First Name *

Physician Phone *

Hospital/Clinic *

Remark

5. Tuition and material: (Please make check payable to: Michigan Chinese School)

Number of students *

(1) USD 170 per student for 1st and 2nd student *

(2) USD 135 per student for 3rd and 4th student from the same family *

(3) Material fee USD 20 per student ( only for those who had never paid this fee in this school year ) *

(4) Only current enrolled students pre-register by 1/23/2016 can waive the registration fee USD 20. You also MUST hand in/mail out your payment on or before 2/6/2016 to the school after you done the pre-registration to waive this registration fee *

Total amount ( USD ) = (1) + (2) + (3) + (4) *

Check Number.

I/We, parent/guardian of above student(s), hereby release, discharge and agree to hold harmless, the Michigan Chinese School and Ward Church, their representatives and assigns, and all persons acting under their permission and authority, from any liability whatsoever for any and all claims of any nature which may arise out of attendance (including myself/ourselves and our minor(s)) at the above said schools during the above said school year. This release covers myself/ourselves and any of my/our family members.

Parent/Guardian Signature *

Date ( MM/DD/YYYY ) *

Referral. Please tell us the name of referral.

Comment / Suggestion

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