2024-2025 Registration Form for Heritage Class (母語班）
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Email *
Student Number on the Roster (For Office Use only)
Does this new student already have siblings enrolled in MLCC? If yes, please indicate their name & grade (e.g., Amy Lin, SSG3).  If no, please answer n/a. *
1. Student's First Name in English *
2. Student's Last Name in English *
3. Student's Name in Chinese （If no Chinese name, put N/A) *
4. Student's Date of Birth *
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DD
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YYYY
5. Gender *
6. Parent's Name *
7. Parent's Email *
8. Student's MLCC Email （For Office Use Only)
9. Parent's Mobile Number 1 *
10. Parent's Mobile Number 2 (or Emergency Contact) *
11. Grade to Enroll *
12. In-person Class: Campus & Hours (skip item 13 if you select in-person class; skip item 12 if you select online class)
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13. Online class: Grade & hours (Please note: Online class for Pre-K & K is not available)
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14. Primary Language Spoken at Home *
15. If the student is transferring from another language institute, please indicate the school name and the current grade.
16. Payment Amount (Tuition fee for in-person classes) (skip item 16 if you select online class)
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17. Payment Amount (Tuition fee for online classes) (skip item 17 if you select in-person class)
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Payment Method (Please write student's English name, class to enroll and campus location on the check or PayPal note.) *
Check number (Please write student's English name, class to enroll and campus location on the memo line.）
Your PayPal Account Email (Please indicate student's name, class to enroll and campus location in your payment.）
Refund Policy: A charge of $50 will be applied to cancellations made by 8/1/24; $100 will be charged for cancellations made before 9/8/24; no refund will be available after that. Returned check fee $30. Full tuition will be refunded if class is cancelled due to insufficient enrollment. *
Mandarin and Language Cultural Center cannot guarantee that unauthorized third parties will not be able to defeat our online learning platform's security measures. Please notify us immediately of any compromise or unauthorized use of your account by email. Through our online instruction, you and/or your child may have the ability to access and/or use content provided by instructors, other users, and/or other third parties and links to websites and services maintained by third parties. Mandarin Language and Cultural Center cannot guarantee that such content will be free of material you or your child may find objectionable or otherwise inappropriate or of malware or other contaminants that may harm your computer, mobile device, electronic device, or any files therein. Mandarin Language and Cultural Center disclaims any responsibility or liability related to your access or use of, or inability to access and use, such content. *
LIABILITY WAIVER STATEMENT FOR VIRTUAL CLASSES:  I acknowledge that certain activities in which my child may participate, either in person or online, may carry the risk of injury. On behalf of myself, my child, and my family, I do herewith waive, release, and forever discharge, to the fullest extent permitted by law, Mandarin Language and Cultural Center, its president, instructors, and employees, of any and all liability for damage, injury, or expense of any kind arising out of or connected with my child's participation in activities provided by Mandarin Language and Cultural Center. *
Do you agree to receive MLCC's emergency notices using the first mobile number you provided above? MLCC will use Twilio, a third-party SMS platform, to deliver emergency notices to you. Message & data rates may apply. Unsubscribe at any time by sending a note to mlcc@mandarinschool.org
 *
Every year, MLCC provides teacher training to meet our needs for language teachers. If you are interested in teaching Mandarin at MLCC, please complete the following survey and check all applicable boxes.
Notes or Comments
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