Chong Wa School
522 7th Ave. S., Seattle, WA 98104, Phone: 206-623-2527,
http://School.ChongWa.org; [email protected]
Registration From (註冊單)
Student English Name (英文名字): ________________________________; Age: ____(for Youth Class)
Student Chinese Name (中文名字): _______________________________
Address (地址): _______________________________, City: _____________, Zip Code: __________
Phone (電話): Home (家) __________________; Cell (手機) ___________________
E-mail (電郵): ____________________________
Guardian Name (監護人): __________________
Guardian Phone (電話):______________; Guardian E-mail (電郵): ____________________________
Person(s) Picking Up Child (接小孩下課的家長): 1. ___________________ Phone: _______________
2.___________________ Phone: ________________
Emergency Contact (緊急聯絡人): ___________________ Phone (電話): ________________
Term (學期):
Year (年) _________;
Fall (秋季)____; Spring (春季)____
Program (課程):
__Weekday Youth After-School Program (週日中文和正規課程輔導) Tuition $480__+ Book $10__
__Saturday Youth Chinese Program (週六中文課程) Tuition $200__ + Book $10__
__Saturday Adult Citizenship Program (週六成人入籍班) Material Fee $5__
__Saturday Adult ESL Program (週六成人英文班) Material Fee $5__
__Adult Mandarin Program (成人中文課程) Tuition$180__; Book(s) purchased by students.
__Adult Cantonese Program (成人廣東話 課程) Tuition$180__; Book(s) purchased by students.
Total Due: $________ (tuition, book and material fee due at registration)
Please Note: Tuitions include $20 non-refundable registration processing fees. All tuitions are not refundable after four weeks of classes.
Within the first week, refund is 90% of (tuition fees minus $20). Within the second week, refund is 80% of (tuition fees minus $20). Within
the third week, refund is 70% of (tuition fees minus $20). Within the fourth week, refund is 50% of (tuition fees minus $20). Book and
Material fees are not refundable. Chong Wa School does not discriminate based on race, age, gender, national origin, sexual orientation,
religion or disability.
(CW School Record ---2016-17 version)
Total Due: $__________ Check #________; Cash________ ; Note:___________________________
Received by: _______________________________________ Date:____________________