Student Information Form

Part 1/2: Basic Information

*Submitting this form does not guarantee you a spot at our center, please contact us to officially register.

Your Child

First Name

Last Name

Date of Birth

MM

DD

YYYY

Gender

Date Beginning School

MM

DD

YYYY

Does your child speak Mandarin Chinese?

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother/Guardian

First Name

Last Name

Mother/Guardian Date of Birth

MM

DD

YYYY

Mother/Guardian Phone

(###)

###

####

Mother/Guardian Email

Father/Guardian

First Name

Last Name

Father/Guardian Date of Birth

MM

DD

YYYY

Father/Guardian Phone

(###)

###

####

Father/Guardian Email

Authorization to Release

The following individuals, other than guardian(s) listed above, will be allowed to pick up your child from our center. Special exceptions can be made by written consent. (Must bring ID) If none, please enter "N/A"

Part 2/2: Medical information & Authorization

Please print, sign and return to our office.

Click here to download Part 2/2