BREMERTON CHINESE LANGUAGE SCHOOL

P. O. Box 344, Keyport, WA 98345

Email: sopbrang@hotmail.com                    Tel: (360) 697-6748

     
     Registration is in progress throughout the year
     2023 - 2024 school year Registration Fee : $10.00 / semester

     2023 - 2024 school year Tuition Fee : $280.00 / semester
     $279.00 / semester ( 2nd child and on from the same household;
     group fee for 3+)
 

開學日期：                                                                結業日期：

Class Beginning:                                                        Class ending:

上課時間：                                                                上課地點：

Class Time:                                                                 Class Place:

 報名費：                                                                   學費：

Registration Fees:                                                     Tuition Fees: $

報 名 表    Registration form

學生英文姓名：

Student English Name:_________________________________ 

中文姓名：                            

生日：                                                            性別：

Birth Date: _________________________________   Sex: ___________________

住址：

Home address: _________________________________________________________________________

就讀學校：

Name of School Attend: __________________________    Grade : ______  
Tel: ___________________

家長或監護人：

Name of Parents or Guardian : ______________________________________          Tel : _________________

住址：                                                            Address:_______________________________________________________________________

緊急事故通知人：                                                                            電話：

Name of Emergency Contact Person: _______________________________ 
    Tel : _________________

住址：

Address : ______________________________________________________________________

家庭醫師：                                                                                        電話：

Name of Family Doctor : _____________________________________________         Tel : _________________

地址：

Address : ________________________________________________________________________

倘遇學生緊急意外情形是否委託本校代為處理？

In case of emergency happen to student, would you mandate school to handle that case and /or contact your family doctor? 
是Yes : ___________ 否No : ______________

家長或監護人簽名:

Signature of Parents or guardian:________________________________________ 日期 Date:                        

A Waiver for Claim of Damages form must be signed prior to school starting. This can be done at the time of your student's first class. Waiver for Claim of Damages form will be provided by the teacher.