CCCLA 2019 Spring Registration Form

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CCCLA provides to all interested parties the opportunity to learn the Chinese language and culture regardless of color, race, or religious belief.

Email *

SECTION 1 PARENT / GUARDIAN INFORMATION

Full Name of Parent / Guardian 1 *

Chinese Name of Parent / Guardian 1 (if any)

Full Name of Parent / Guardian 2 (if any)

Chinese Name of Parent / Guardian 2 (if any)

Address, City, State *

Zip Code *

Mobile Phone Number *

SECTION 2. REGISTRATION AND TUITION

How many students to register? *

One ($210)

Two ($400)

Three ($600)

Number of Students

Parent-Teacher Association Membership *

New family, add $20 to your registration fee.

Returning family of this school year, no extra cost.

SECTION 3. STUDENT INFORMATION

Full Name of Student 1 *

Chinese Name of Student 1 (if any)

CCCLA Class to Enroll, Student 1 *

Full Name of Student 2

Chinese Name of Student 2 (if any)

CCCLA Class to Enroll, Student 2

Full Name of Student 3

Chinese Name of Student 3

CCCLA Class to Enroll, Student 3

SECTION 4. OTHER INFORMATION

Photo and Directory Release

CCCLA periodically publishes photos of students on its website and closed facebook group, and a school directory for each CCCLA family.

check this box if you do NOT wish your child’s photos be published on the website

check this box if you do NOT wish to be included in the directory, please check the box.

Sexual Misconduct, Liability and Medical Release *

I hereby release Kenwood Baptist Church, 8341 Kenwood Road, Cincinnati, Ohio 45236, from any and all liability related to sexual misconduct charges brought against the Cincinnati Chinese Culture Learning Association (CCCLA), its teachers, agents, administrators, or visiting adults in consideration of its agreement that I be permitted to use Kenwood Baptist Church property at 8341 Kenwood Road. This release does not apply in the event of Kenwood Baptist Church gross negligence of willful misconduct. I hereby further release and discharge the CCCLA, its teachers, officers, and representatives from any and all obligations and/or liability resulting from accidents, injuries, or otherwise occurring as a result of my child’s participation in, or attendance at any CCCLA’s activity. In the event that my child becomes ill or injured during any CCCLA activity, its officers , teachers , and representatives have my permission to have reasonable adequate medical services provided to my child, including the transportation of my child to an appropriate emergency medical facility.

I have read the above release, and I understand and agree fully with its provisions.

Required

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