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2022-2023 Afterschool Program Registration Form
WALNUT CHINESE LANGUAGE CENTER
20850 CARREY RD. WALNUT, CA 91789
909-594-8880
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* Indicates required question
Email
*
Your email
Enrollment Type
*
Afterschool Program 課後班
Chinese Only 中文班
Transportation
*
Needs pickup service from school 自学校接送至WCLC
No pickup needed
Required
Student Name 姓名 (Chinese and English )
*
Your answer
DOB 生日
*
Your answer
Gender 性別
*
Male 男
Female 女
School 目前就讀學校
*
Your answer
Grade 年級 on August/2022
*
Choose
1
2
3
4
5
6
7
Chinese Proficiency 中文程度
*
None 未讀過
Pinyin
Last completed Chinese textbook level 已讀完美洲或其他 ____ 第____冊
*
Your answer
*
Traditional 繁體
Simplified 简体
Native Language 母語
*
Mandarin 國語
Cantonese 粵語
English 英語
Other 其他
Required
Address 住址
*
Your answer
Parent/Guardian Name 父母 / 監護人名字
*
Your answer
Parent/Guardian's relation to the student 關係
Mother 母親
Father 父親
Other 其他
Clear selection
Parent/Guardian's Phone Number (Home)
Your answer
Parent/Guardian's Phone Number (Cell)
*
Your answer
Parent/Guardian's Email
*
Your answer
Family Doctor's Name and Telephone
Your answer
Make Payment
*
by Check 以支票支付
by Zelle (
wclc20850@gmail.com
)
other 其他
Required
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