After School Registration

After School Registration Form

* Indicates required field

Student(s) Name *

Date of Birth *

Gender *

Street Address *

City, State Zip *

Parents Name *

Relationship to Student *

Home Phone *

Cell Phone *

Email *

Campus *

School Name *

Referred By *

Medical Authorization
In case of emergency, give names of persons who can be called
and are authorized to pick up your child if we cannot reach a parent.

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Student(s) *

I understand that every effort will be made to contact me in the event of an
emergency requiring medical attention for my child. However, if I cannot be
reached I hereby authorize Koo Chinese Academy to transport my child to the nearest
hospital and to secure for my child the necessary medical treatment.

Parent/Guardian Signature and Date *

Photo/Video Permission
When after school is in session, there are times when pictures or videos may be
taken to showcase an activity or an event. Photos or videos may be used internally
or in school marketing materials, including our school’s website.

Yes, I gave my permission to use pictures or videos of my child taken in the program, including on the internet and in printed materials. Yes, I gave my permission to use pictures of my child on facebook. No, I do not give my permission to use pictures or videos of my child taken in the program.

Allergies: If your child has any allergies or health concerns, please list them all *

Comments or Suggestions *

Registration Fee
There is a $25 application fee for New Student Registration Only.

Tuition Fee
Branchburg Campus: 5 days $400/month， 4 days $352/month，3 days $276/month，2 days $192/month
Basking Ridge Campus: 5 days $440/month， 4 days $390/month，3 days $320/month，2 days $230/month

Sibling Discount
10% sibling discount for each additional child (on the lesser tuition).

Cancellation Policy
No refunds for the month are provided after the month has started.
We reserve the right to modify or cancel classes based on enrollment.

I have read and understand Koo Chinese Academy After School cancellation policy.

We look forward to seeing you at our After School program.

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