光啟中文學校2021-2022學年註冊表 Kuangchi Registration Form
School Starts 學校開課 Sat 週六 9/11/2021

- Kuang Chi 光啟中文學校

上課時間--星期六 Saturday Class time: 1-2:45pm
文藝課Culture classes: 2:55-3:45pm

School Location: St.Mary's School Rockville
600 Veirs Mill Rd., Rockville, MD 20852
***整年學費：每位學生$480.00 | Whole Year Tuition ： $480.00 per student***
報名費每個家庭$20，PTA 費用每個家庭 $20
Registration Fee $20 Per Family each year, PTA Fee $20 Per Family each year

學費 Chinese Class tuition $480	$480
文藝課 Culture Class $120	$120 (optional class)
家長會費 PTA Fee $20	$20
註冊費Registration Fee $20	$20
自由捐助 Donation
支票總計 Payable Check Total	$520 第一個學生 First Student, $480 兄弟姐妹 Any Siblings

退費標準：第二週以前退100%; 第三週以前退75%; 第四週以前退50%; 第五週以後不退; 註冊費不退
Refund Policy: 100% refund before 2^nd week; 75% refund before 3^rd week; 50% refund before 4^th week; No refund after 5^th week (included); No refund for registration fee $20.00

***2021秋季課程學校策劃用 St.Mary's School Rockville 星期六9/11/2021開課。 Fall 2021 classes will be held in-Person at St.Mary's School Rockville starting Sat 9/11/2021***

The maximum number of form submissions has been reached. This form is currently not available.
- 請為每個學生填寫一份表格。Please fill one form out per student.
  付款支票可以合併。Payment checks can be combined.
  有問題可以使用 “Contact School 聯絡學校
  Questions，please use "Contact School" link
  支票抬頭 Check payable to：Our Lady of China (KuangChi),
  請郵寄支票至 Please mail check to:
  KuangChi Chinese School
  12225 Seline Way
  Potomac MD 20854
- 學生中英姓名 Student Chinese(optional) and English Name REQUIRED Please fill out this field. Please enter valid data.
- 整年學費Whole Year Tuition:
  請標記所有適用項，然後將總數加起來。Please mark all applies and add up the total.
  $520 第一個學生中文课 First Student Chinese Class ($480 + $20 註冊費Registration +$20 家長會費 PTA ) $480兄弟姐妹中文课 Additional Siblings Chinese Class ($480 + $0 註冊費Registration +$0 家長會費 PTA) $120 文藝課扯鈴Chinese Yoyo Culture Class $120 文藝課中國舞蹈Chinese Dance (三年級及以上3rd Grade and Higher) $120 文藝課捏陶 Miniature Clay Class 自由捐助 Donation
- Weekly Free Student Chinese Tutoring 每週大學生免費輔導 Request Weekly Free Student Chinese Tutoring 注册每週免費學生辅导中文不需要學生免費輔導 Do not need Student Tutoring Can Volunteer Tutor Younger Chinese Students可以幫忙免費輔導小學生
- 支票總計 Payable Check Total
  總計項目Total up the items。
  Please enter valid data.
- 學生資料 (Student Information)
  
  父親手機號碼(Father Cellphone) Please enter a phone number.
  
  母親手機號碼(Mother Cellphone) REQUIRED Please fill out this field. Please enter a phone number.
  
  父親電郵 Father Email Please enter an email address.
  
  母親電郵 Mother Email REQUIRED Please fill out this field. Please enter an email address.
  
  父親英文姓名 (Father's English Name) Please enter valid data.
  
  父親中文姓名 (Father's Chinese Name) Please enter valid data.
  
  母親英文母姓名(Mother English Name) REQUIRED Please fill out this field. Please enter valid data.
  
  母親中文姓名(Mother Chinese Name) Please enter valid data.
  
  學生出生日期 Student Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  性別 Sex REQUIRED 男 Male 女 Female Please fill out this field.
  
  地址(Address) REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  秋季美國學校年級 Fall American Grade Level REQUIRED Please fill out this field.
- 中文班年級 Chinese Class Grade REQUIRED Please fill out this field.
- 緊急聯絡人Emergency Contact Person
  
  緊急聯絡人中文姓名(Chinese Name) Please enter valid data.
  
  緊急聯絡人英文姓名(English Name) REQUIRED Please fill out this field. Please enter valid data.
  
  與學生之關係 (Relationship) REQUIRED Please fill out this field. Please enter valid data.
  
  電話號碼(Home) / 手機號碼(Cell) REQUIRED Please fill out this field. Please enter a phone number.
- 免責授權: 本申請人瞭解並同意學生在校學習及各項活動期間之醫藥與意外保險概由各學生之家長或監護人負責，一切與光啟中文學校無關。
  
  Waiver: I understand that Kuang Chi Chinese School assumes no responsibility for injuries or accident which my child may sustain as a result of his/her physical condition or resulting from his/her participation in any activities, the use of any equipment, exercise, or other activities.
- 申請人(家長監護人) 簽名(Applicant’s (Parent’s/Guardian’s) Signature):
  I Agree 同意 Please select this field.
- 家長簽字 First Last Name Signature REQUIRED Please fill out this field. Please enter valid data.
- 日期 Date REQUIRED Please fill out this field. Please enter a date.
Submit

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光啟中文學校2021-2022學年註冊表 Kuangchi Registration Form School Starts 學校開課 Sat 週六 9/11/2021

光啟中文學校2021-2022學年註冊表 Kuangchi Registration Form
School Starts 學校開課 Sat 週六 9/11/2021