Registration Form

學生英文姓名
English Name

中文姓名
Chinese Name

生日
Birthday

課外活動
Extra Curriculum

需學分轉換
Accreditation (Y/N)

天樂語文學校
Great Joy Chinese School
400 Murchinson Dr., Millbrae CA 94030
Tel: 650-692-9166 / Fax: 650-552-9379
Mailing Address: P.O. Box 806, Millbrae, CA 94030
E-mail: GJCS94010@Yahoo.com / GreatJoySchool@aol.com

Date日期
Check 支票號碼
Amount 金額
Cash 現金
Total 總額

Parent's Information:
家長(監護人)姓名 Parents/Guardian: ______________________________________________
地址 Address: _________________________________________________________________
電話 Tel: ________________________________傳真 Fax:_____________________________
手提電話 Cellular Phone: ________________________________________________________
E-mail:_______________________________________________________________________

__________學年註冊單(Registration Form)

家庭使用語言 Language Spoken at Home:

國語 Mandarin _____粵語 Cantonese _____ 英語 English _____其他 Other:______________
願意學 Want to Learn Written Language in 簡體字 simplification ___ or 繁體字 tradition ___

Emergency Contact (s):

緊急情況聯絡人 Name: ______________________關係 Relationship: _________________
電話 Telephone: ____________________________

Authorization 家長同意書:

· I give permission for my child/children to participate in the GJS program. I will not hold the school or any staff member liable in case of accidents or injures. In case of emergency, I authorize for my child to receive medical treatment at Peninsula Hospital at my own expense. No refund after the school begins.
· 本人同意上列報名子女參加天樂語文學校各種課業活動. 並同意如果發生意外事故 , 不向學校或學校職員, 理事追究責任. 本人子女若因故受傷, 本人允許學校逕送 Peninsula 醫院治療, 並願意負擔全部費用. 開課後恕不退費.

家長/監護人
Parents/Guardian

簽名
Signature:______________________________

日期
Date:______________________