Please print this form out, fill all necessary information in and hand it to school program organizer
Hui xu Cheng. Or you can fax this registration form to 833 4868.
--------------------------------------------------------------------------------------

  Madison Eagle Heights Chinese School
Fall 2001 Saturday Morning Program Registration Form

                                                       Mailing address: 202 N High Point Rd, Madison, WI 53717
                                Telephone/Fax: 608 833 4868   http://mehchineseschool.20m.com   Tax ID 39-4172831

Student's Name: _____________________(English)     _____________(Chinese, if any)

Student's Date of Birth: _______________

Father's Name ______________  phone number___________________

Mother's Name _____________   phone number___________________

Home Address ________________________________ Zip Code _________

Home  Phone Number: _____________ E-mail address:________________________ (please print)

Emergency Contact Person: _________________ Telephone Number:_______________

Please check the desired program(s) to be enrolled in:

September 8 - December 15,   14  weeks Program
 
            Class Name Class Time                 Fees  Class Room
(     )Chinese Class One  9:30 - 10:15 am             $63 R106              4 - 5 yrs old
(     )Chinese Class Two  9:30 - 10:15 am             $63 R133                    5 - 7 yrs old
(     )Singing & Dancing One  10:25 - 11:10 am           $63 small Gym             4 - 7 yrs old
(     )Special Chinese Class One 10:25 - 11:10 am           $63 R106              4 - 5 yrs old
(     )Special Chinese Class Two 10:25 - 11:10 am           $63 R133                    5 - 6 yrs old
(     )Art/Craft 10:25 - 11:10 am           $63 R135                    4 - 6 yrs old
(     )Singing & Dancing Two 11:20 am - 12:05 pm      $63 small Gym             4 - 6 yrs old
(     )Adult Chinese Class 11:20 am - 12:05 pm      $63 R135
(     )Chinese class Three 11:20 am - 12:50 pm      $98 R133                 9+ yrs old
(     )RSCC 11:20 am - 12:30 pm      $98 R106                    5 - 7 yrs old
*RSCC stands for Regular Special Chinese Class

Total Amount Paid_________________ Please make check payable to MEHCS.

*The whole payment should be made at the first day of the semester unless the special agreement has been made. Cash or check are all acceptable.
*Please check our web page to find out the details of our school regulations before making payment.

Thank you

Parents’ Signature:  ________________________ Date:___________________

Go Back to MEHCS Home Page