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暑期班注册表
发布日期:2010-04-19   阅读次数:1836

      伟博教育中心暑期班注册表
WEI BO LEARNING ORGANIZATION SUMMER CAMP REGISTRATION FORM
  136-20 38AVE 9A FLUSHING NY 11355      TEL: 718-353-5599  646-666-3778
中文和英文姓名Chinese Name & English Name    ___________________________________________
性别Gender    _________出生日期 Date of Birth  ________________________年级Grade  ________
可以接我孩子之人________________________________________________________________                                                                   
Names of parents that can pick up my child  日间校名Day School Name_____________
地址Home Address    __________________________________是否接送 Pick Up & Send Home____
家长或监护人姓名Parent or Guardian ________________________电话Tel _____________________
上课日期Weeks Registered:    Form ____/____  To____/____,  Total: ______周Weeks.
就医授权:假如发生意外事故,唯恐伟博教育中心联络不到您,能否请提供两位可以代替您照顾或负责学生
就医的亲戚朋友的电话If your child gets into an accident and we are unable to reach you, please  
list two relatives or friends who will take responsibility in seeking medical attention.
紧急联系人姓名电话 NAME & TEL OF PERSON/S TO CONTACT IN CASE OF EMERGENCY (OTHER THAN PARENT) 
1.________________________________________   2.____________________________________
家庭医生Family Doctor_______________________               电话Tel    _______________________
是否有过敏Any Allergies ____________________________________________________________  
I do hereby grant permission for _____________(Student's name) to attend Wei Bo Summer Camp from 
7/1/2010 to 8/13/2010 sponsored by Wei Bo Learning Org. Inc. and take full responsibility if anything
should happen to my child. I hereby absolve Wei Bo Learning Org. Inc. of any legal responsibility. 
学生家长签名 Parent's Signature_______________日期Date___________与学生关系Relationship_______
—————————————————————————————————————————————————
以下部分由学校填写                                                                                                                    学号No. Bitmap
学费 Tuition                              注册费Registration Fee                                 制服Uniform                                      
合计Total                                 (自From :日期Date                                   至To:日期Date                                   
合计实付Total Payment   $                                                       尚欠Due $                                                    
经办人签名Recipient of this registration & payment_____________     日期Date_____________________
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