Online Chinese Class Registration

Online Chinese Class 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 *

Referred By (new student only) *

CLASS SCHEDULE: starting from the week of September 10 to the week of December 17 2018, total 15 weeks classes. please select to enroll: *

Heritage Chinese Group Class Grade 1 (Every Monday 7:45 PM - 9:15 PM) Heritage Chinese Group Class Grade 2 (Every Monday 6:00 pm - 7:30 pm) Heritage Chinese Group Class Grade 3 (Every Friday 6:30 PM - 8 PM) Private or Semi-Private Class (two 45 minutes classes per week for 15 weeks) Private or Semi-Private Class (One 45 minutes class per week for 15 weeks)

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) *

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. No, I do not give my permission to use pictures or videos of my child taken in the program.

Comments or Suggestions *

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

Tuition Fee
- $450 for each Group Class
- $1200 for private class (two class per week for 15 weeks)
- $600 for private class (one class per week for 15 weeks)
- Call for price of semi-private class

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

Cancellation Policy
Complete refund in two weeks after the class starts. Thereafter, no refunds.
We reserve the right to modify or cancel classes based on enrollment.

I have read and understand Koo Chinese Academy Online Chinese Class cancellation policy.

We look forward to seeing you at our Online Chinese Chinese Class.

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