FEES
One Session: $195; Two Sessions:
$380
Fee for Second Child: One Session: $185; Two
Sessions: $360
One Session: $185; Two Sessions:
$360
Fee for Second Child: One Session: $175; Two Sessions: $340
FOR MORE INFORMATION, CALL:
Mrs. Margaret Kung (301)
340-3164
Mrs. Grace Chen (301)
424-4331
With a Check Made Payable to
Washington
Chu Shan Chinese Opera Institute, Inc.
Registration
Form---------------------------------------------------------------------------------------------------------------------------------
Name:__________________________________________
First
M.I.
Surname
Chinese
Name
Date of Birth: ________________ Grade: _________ Sex: ________
Phone: (H) ( ) _____-_______; (W) ( ) _____-_______
Parent/Guardian Names:
_____________________________________
Address: _________________________________________________
City: ___________________ State: __________ Zip Code: ________
E-mail: ___________________________________________________
Chinese Language Proficiency (check one):
( ) None ( ) Basic ( ) Good ( ) Excellent
Select Appropriate Age Group:
( ) Group A ( ) Group B ( ) Group C
( )Attending One Session (check one):
( )July 22 – July 26 ( )July 29 – August 2
( )Attending Both Sessions
Program Fee Total for First Child: $__________
Program Fee Total for Second Child: $__________
Total Program Fees: $ _________
HEALTH/SAFETY INFORMATION
Family Physician: ____________________ Tel. # ( ) ____-______
Health Insurance Co:__________________ Policy #: _____________
Emergency Contact:__________________ Tel. #: ( ) ____-______
Emergency
Contact:___________________
Tel. #: (
) ____-______
PARENTAL RELEASE AND CONSENT
TO MEDICAL TREATMENT
My child is enrolled in “A
Journey Along the Path of Traditional Chinese Performing Arts.” I understand that my child may
participate in certain educational or recreational programs of which may pose a
risk of accidental injury. We will
make every effort to maintain a high level of safety in conducting the
activities but this does not guarantee the safety of my
child.
I hereby release The Washington Chu Shan Chinese Opera Institute Inc., Rockville Chinese School and Washington School of Chinese Language and Culture, its employees, representatives, members of the Board of Trustees, from any and all liability for injuries to my child or damage to any property of my child. I accept the full risk and responsibility for any damage or injury. In any legal proceeding brought in regard to this release, Rockville Chinese School shall be entitled to recover all costs and expenses of such actions, including but not limited to reasonable attorney’s fees.
I further authorize Rockville
Chinese School personnel to administer First Aid and/or transport my child to a
physician or hospital and to consent to emergency medical treatment required for
my child, if a parent or guardian cannot be reached.
Parent or Guardian’s Signature:______________________Date: _______
Contact Person: ______________________________________________
| [ Home | Overview | Artists | Exhibitions | Productions | Summer | Workshops | Events ] |