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Heritage Chinese Language Class Registration Form
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Date of Birth
City, State Zip
Relationship to Student
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
When camp 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 at class, 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 at class.
Check Day(s) Your Kid Would Like to Attend
Allergies: If your child has any allergies or health concerns, please list them all
Comments or Suggestions
There is a $25 application fee for new student registration only.
$360 per semester (total 18 weeks, 2 hours per week).
10% sibling discount for each additional child.
30 Day Money Back Guarantee, No Question Asked.
We reserve the right to modify or cancel classes based on enrollment.
I have read and understand Koo Chinese Academy Chinese Language Classes cancellation policy.
We look forward to seeing you at our
Chinese Language Classes!
©2018 Koo Chinese Academy. All Rights Reserved.
Branchburg Campus: Branchburg Commons, Suite 501,
US Highway 22, Branchburg, NJ 08876
Basking Ridge Campus: Highlands Village Center, 564 Allen Road, Basking Ridge, NJ 07920