Koo Chinese Academy: 2023-2024 School Year Enrollment
This is a consolidated enrollment form for all of our following programs during 2023-2024 school year:

After School Program and Classes
Weekend School

http://koochinese.com | phone: 908-326-6390 | wechat: fredluofeng | 564 & 560 Allen Road, Basking Ridge, NJ 07920
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Email *
Student Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
School Name
Grade in Regular School (in 2023-2024 school year)
Home Address Street
Home Address City, State, Zip Code
Parent/Guardian Name
Relationship to Student
Home Phone
Cell Phone *
For new student, where did you hear us?
Clear selection
Referral and Group Buy
1. Referral:  Only if your child is a New Student (has never enrolled in any Koo Chinese Academy program therefore does not exist in our database), and you are referred by A family of our existing student to Koo Chinese Academy, please list that student's full name in the Referred By field below! Referral does NOT apply to any current or prior student of Koo Chinese Academy!
 
2. Group Buy: A Valid "Group Buy" group is defined as having one old student and one or more new students, or all new students. Any new students are not from the same families of any old students of our academy. $50 off for each student in the group provided all students in the group enrolls within 24 hours!  

3. Once a New student is in a Group Buy, please don't fill the "Referred By" field as any referral in the "Referred By" field becomes invalid!
Referred By (for new student, if any, can not be combined with group buy)
If this is a group buy (团购), please enter your groupmate's full name here (you can only join one group). Once the group buy succeeds, you will get $50 group buy discount.
Special Promotion Code (such as Open House Special Discount, etc)
Photo/Video Permission *
Medical Authorization
In case of emergency, give names of persons who can be called and are authorized to pick up your child if we cannot reach a parent.
Emergency Contact Name
Emergency Contact Phone
Relationship to Student
Allergies: If your child has any allergies or health concerns, please list them all *
Parent/Guardian Authorization
I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached I hereby authorize Koo Chinese Academy to transport my child to the nearest hospital and to secure for my child to necessary medical treatment.
Parent/Guardian Signature and Date *
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