REGISTRATION FORM 微信 ID FAMILY INFORMATION. GHCS Family ID (Skip this if never registering in GHCS) Member of GPCCC: Home address:

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1 2018 Greater Philadelphia Chinese Cultural Center Summer Program June 25 June 29, July 2 July 6, July 9 July 20, July 23 July 27, July 30 Aug 3, Aug 8 Aug10, Aug 13 Aug17, Aug 20 Aug 24, Aug 27 Aug 31 REGISTRATION FORM FAMILY INFORMATION GHCS Family ID (Skip this if never registering in GHCS) Member of GPCCC: Mother s name: Mother s cell: Father s name: Father s cell: Home address: City: State/Province: Postal/Zip Code: Parent Emergency contact: Emergency Contact Phone: 微信 ID Relationship: PARTICIPANT INFORMATION Last Name: First Name: Gender: Female Male Date of Birth Age: Grade attended year at GHCS T shirt size: Youth S, Youth M, Youth L, Adult S, Adult M, Adult L Specify your child s health problems: Is your child on any medication? N o Yes If so, please specify: 1

2 REGISTRATION INFORMATION (Please circle the week you are enrolling) Full day 8:00am 4:00pm Please circle the theme you would like to do for the week 4:00pm 5:00pm 5:00pm 6:00pm Weeks #1 6/25 6/29 $350 Chinese Cultural Week #2 7/2 7/6 $350 Adventure Week $40 $40 #3 7/9 7/13 $0 Qiao Ban Mingshi Tuan #4 7/16 7/20 $0 Qiao Ban MIngshi Tuan #5 7/23 7/27 $ Imovie 2. Children Drawing #6 7/30 8/3 $ Imovie 2. Album Making #7 8/6 8/10 $ Chess 2. Pingpang 3. Chinese Story #8 8/13 8/17 $ Robotic for Beginner 2. Computer Coding 3. Chinese Story #9 8/20 8/24 $ Chinese Folk Dance 2. Drawing #10 8/27 8/31 $350 Chinese Cultural Week One Day $90 $10 $10 Registration for Qiao Ban Mingshi Tuan and Deposit 1. Registration Fee x $80 = 2. Number of Weeks (Qiao Ban Mingtuan Weeks only) X 1 = 3. Deposit ($100/week) x $100 = Payment for Qiaoban Mingshi Tuan (The registration fee is not refundable. The deposit is to secure your spot and is not refundable if you don t attend the program for any reason. Please write in different check for the registration fee and deposit. On the check, please indicate camper s name at the memo area) (Name of Participant 2

3 Registration for GHCS Summer Program and Payment Information 1. Registration Fee for GHCS Summer Program X $15 2. Number of Weeks registered (GHCS Summer X $350 = Program Tuition) 3. Deposit ($100 each week registered, GHCS only) x $100 = 4. Number of One Day programs (Field Trips) x $90 = Discount (Min. 2 weeks of Full day program registered. Any Discount is NOT applicable for One Day program. All discounts are only applicable to tuition.) 5. GPCCC Member (10% ) x 0.90 = 6. Guanghua Chinese School Student ( ) (5%) x 0.95 = 7. Siblings (Older one 10%) x 0.90 = 8. Returned Campers (5%) x 0.95 = 9. Early Bird by March 18 (10%) x 0.90 = 10. Open House on Feb 4 (5%) x 0.95 = Extended Care: 11. Number of Hours for extended hours x $50 = Final Payment (qiaoban mingshi tuan and GHCS) Total Registration Fee, Tuition, and Extended Care Check # Credit Card $ *Total Deposit (Both Qiaoban Mingshi Tuan and GHCS) Check # $ *(The registration fee is not refundable. The deposit is to secure your spot and is not refundable if you don t attend the program for any reason. The tuition and extended care fee are refundable before June 3 rd (Last day of Chinese School). Please write in different check for the (Registration Fee, Tuition, Extended Care) and deposit. On the check, please indicate camper s name at the memo area) (Name of Participant 3

4 PAYMENT METHODS Payments: Tuition may be paid by credit card or by check. Make the check payable to: Guang Hua Chinese Association The check can be dropped off at the school office 345 during school hours or be mailed Greater Philadelphia Chinese Cultural Center 905 Lenmar Drive Blue Bell, PA Attn: Summer Programs. Contact Information For more information, contact Xianghong Zhang, Summer Program director at s: SIGNATURE OF PARENT OR GUARDIAN DATE I understand that the balance is due by June 4. We do not provide make ups or refunds for any days missed for any reason. REQUIRES PARENT S SIGNATURE: You have our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child as they may deem advisable. Parent/Legal guardian name Parent/Legal guardian Signature Date Date Student Allergies Student Medical Problems Doctor Insurance carrier Phone number Policy number PARENT STATEMENT I hereby state that (participant s name) is in good mental and physical health condition to participate in the activities provided by GHCS. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of serious injury. I hereby release GHCS, its employee and its staff from liability to the above named athlete, of the person claiming through him/her, arising from injury to the person or property of the above named athlete occurring in the premises of GHCS, including any event sponsored or sanctioned by GHCS and or travel to and from such activities. Parent Signature Date 4

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