Rocky Mountain Chinese School 洛機山中文學校

Registration Form * Not required for Adult Student

Student First Name: Last Name:

I would like to enroll in:

Panda 1:00-2:00pm (Sundays)	Intro to Mandarin ages 6-9 2:15-3:15pm (Sundays)
Intro to Mandarin Adult 3:30-4:30pm (Sundays)	Adult Level 1 10:30-11:30am (Fridays)
Level 1 4:45-5:45pm (Sundays)

Address:

Email: Phone: Age:

*Parent 1 First Name: Last Name:

*Parent 2 First Name: Last Name:

**If parent 2 contact info differs from the primary contact info, please fill out the below boxes.

Address:

Email: Phone:

Tuition per class/student

1 Semester $180.00

Fall & Spring Semester $360.00

Form of Payment:

Paid with Cash $ Paid with Check#

School Policy: There is no refund or makeup lesson on days missed by students.

School Wavier:

As parents/guardians of the student whose name appears above, I/We hereby release and waive any claim against Rocky Mountain Chinese School, as well as the school officers, directors, agents, employees, and volunteers for any damages or injury suffered by the student on the account of or in connection with the student participation in the any activities. Rocky Mountain Chinese School regular language classes, enrichment classes and other related activities to be held at 1422 Eldorado Drive, Superior CO 80027.

This Waiver and Release of Liability shall operate as a complete waiver and release for any personal injury, missing person, death, and wavier of property or other damage or loss, including loss of use, which may arise in connection with the student’s participation in the above activities.

As a parent/guardian of the student named above, I acknowledge that I am aware of the risks associated with the above activities whether risks are by reason of preparation for participation, transportation of the student, exposing the student to the elements and to the general public, or otherwise exposing the student to risks which may or may not be generally associated with the above activities. I also give permission to Rocky Mountain Chinese School to photograph the above indicated student for the school’s brochure, website, and advertisement.

I as the student said above, over the age of 18, have read and accept the Rocky Mountain Chinese School Waiver.

________________________ ______________________________

Student’s signature Date

*I as parent/guardian of the above said student, I have read and accept the Rocky Mountain Chinese School wavier. Both parents/guardians of above mentioned student must sign this waiver, or unless one of the parents has sole custody of the above student.

________________________ ___________________________ _________

Parent 1 signature Parent 2 signature Date

Print this copy, sign, and mail with payment to

1422 Eldorado Dr. Superior Co 80027