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.
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Madison Eagle Heights Chinese School
Fall 2001 After School Chinese Class Registration Form
                                 Telephone/Fax: 608 833 4868   http://mehchineseschool.20m.com   Tax ID 39-4172831

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:



Fall Semester duration: August 27 - December 21, same schedule as local school

____  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:___________________

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