2024 Summer Academic and Enrichment _SLG
For detailed information, please go to https://hopeccs.org/summerprograms/

Dynamic CLA
The weekly themed curriculum aims to deepen and strengthen Chinese language and cultural experience through hands-on, inquiry-based, and project-based learning. 

Daily class starts at 9:00 a.m. and ends at 12:00 noon, early drop off time from 8:30 a.m. - 9:00 a.m. and pick up time at 12:00 noon.

Free of charge!
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Student Information
(one form per student)
Last Name *
First Name *
Current School  *
Grade (in 2023-24 school year) *
Full Address *
Describe student's experience with Mandarin *
Parent/Guardian Information
Parent/Guardian #1 Full Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #2 Full Name *
Parent/Guardian #2 Phone Number *
Main email address for contact *
Your student will attend: *
Required
Total Camp Cost *
Cost: Free of Charge
Emergency Contact
Please list an emergency contact other than parents/guardian
Full Name *
Relation to Student *
Phone Number *
Authorized Pick Up Other Than Parents:
Please note that you may be asked to show a valid ID when picking up students
Authorized Person Name:
Authorized Person Phone Number:
Relationship to Student
Medical Information
Allergies *
If yes, list all medical allergies below:
Food allergies *
If yes, list all food allergies below:
Medical conditions? *
If yes, please list:
Current medications:
(include prescriptions medications i.e. epi-pens, inhalers, etc, and non-prescription drugs: i.e.aspirin) If medication(s) need to be given during the day or an emergency kit needs to be kept at school, please contact the school for a Medical Administration Form
Doctor's Name *
Doctor's Phone: *
Doctor's office address *
Hospital Preference *
If required, you agree to have your child taken to Providence St. Vincent Hospital
Authorization and Consent of Parent(s) or Legal Guardian(s) *
I do hereby confirm that I have legal custody of the aforementioned minor child. I grant my authorization and consent for "Hope Chinese Charter School representative" (hereafter "Supervising Adult") to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Supervising Adult to summon any and all professional emergency personnel to attend, transport, and treat the participant and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Supervising Adult in the exercise of this or her best judgement upon the advice of any such medical or emergency personnel. This Authorization and Consent is effective from the date designated below and shall remain in full force and effect for such period of time my/our child is enrolled and/or participating in the summer programs at Hope Chinese Charter School.
Yes
I agree with the authorization and consent mentioned above.
I understand any changes in medical conditions or medications, is the responsibility of the parent/guardian to notify Hope Chinese Charter School.
Other Terms & Conditions
I agree to the following terms as indicated by checking the box next to each statement and signing my name below:

*
*
*
Please read: *
Required
Signature of Parent/Guardian *
How did you hear about this camp?
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