Student's Name: _____________________(English) _____________(Chinese)
Student's Date of Birth: _______________
Father's Name ______________ phone number___________________
Mother's Name _____________ phone number___________________
Home Address ________________________________
Home Phone Number: _____________ E-mail address:________________________
Emergency Contact Person: _________________ Telephone Number:_______________
Check the desired program to be enrolled in:
____ Chinese class 3 age: 9-11 yr. old, Mon. 3:50-5:20 pm, Fri. 3:45-5:15 pm $14/week
____ Chinese class 2 age: 6-8 yr. old, Mon. 2:15-3:45 pm, Wed 3:45-5:15 pm $14/week
____ Chinese class 1 age: 5-6
yr. old,
Tue. & Thur. 3:45-5:15 pm
$14/week
__ Collect from Shorewood -- Yes/No (Please circle accordingly)
*Please check our web site at http://mehchineseschool.20m.com
to find out the details of our school regulations
before
making payment.
*For children who needs to be collected from Shorewood
school, an extra $2/week will be added on the payment.
*MEHCS will attempt to contact the emergency contact (if such information is provided on the above) if anything happen to your child(ren) during the school time. But MEHCS is not legally responsible for any such incidence.
Parents’ Signature: ________________________ Date:___________________