BCS Spring 2019 Children Program Registration

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All the programs will be starting in August, unless otherwise indicated.
BCS Membership Fee (once a year): $30/single; $40/family
*Members pay 80% tuition fee for all BCS language and culture classes.
Language Class Tuition Rate: $10/hour (for member only); $12.5/hour (non-member)
Every class needs to have at least two students, otherwise the class will be cancelled without further notice.
Feel free to contact info@blacksburgchineseschool.org if you have any questions regarding registration! If you intend to register for yourself as an adult, please sign up this form: goo.gl/QvPtvM. Thanks!

Email *

Name of Student *

Age *

Date of Birth *

Gender *

Male

Female

Required

Current School *

Mother/Guardian 1 Name *

Mother/Guardian 1 Phone Number *

Father/Guardian 2 Name *

Father/Guardian 2 Phone Number *

Contact Email Address 1 *

Contact Email Address 2 *

Emergency Contact Name *

Emergency Contact Phone Number *

Relationship *

Does your child have any allergies? If yes, please explain.

Has your child taken any Chinese class before? *

Yes

If yes, tell us about what level your child has finished.

Language Program that your child wants to participate

Non-Heritage Chinese (90 mins/Saturday) (For 5+)

Non-Heritage Chinese after-school @ Kipps Elementary

Pre-SAT/SAT/AP (90 mins/Sunday)

Cultural Program that your child is interested in participating: (We will contact you for further information.)

Traditional Chinese Dance - Children Dance Group (girls 8-12 years old)

Chinese Yo Yo Group

Chinese Lion dance group

Chinese Calligraphy class (for age 6+. Ten students max.)

Blacksburg Chinese School Parent/Guardian's Release Form * * *

I give my permission for my child/ myself to participate in the Blacksburg Chinese School programs. I will not hold the Blacksburg Chinese School, facility providers, volunteers, or paid and unpaid staff members liable in case of accidents or injuries, that may occur in any kind of activities administered or sponsored by Blacksburg Chinese School for either students or parents on school site or off school site.

I acknowledge and agree that Blacksburg Chinese School has the right to cancel any class with less than three students enrolled, and therefore refund the full tuition without charge of any processing/administrative fee.

I understand that photographs or videos of me or my child may be taken during said program, that my or my child's likeness may appear in media coverage and publicity regarding said program, for which no compensation in any form will be made by BCS, and I give my consent to these conditions.

Required

Signature *

Parent/Guardian Name

Submit

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