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					                                              CYES 2009 Palo Alto Campus Summer Application                                                    www.championyes.com (3/5/09)
                                       Palo Alto (650)858-1880; Mountain View (650)353-0881                                   Paid Amount: _____ Check#: ____ Balance: _____
                                                                                                                              Paid Date: _______; Starting Week: _____________

English Name: __________________________ Chinese Name: ______________ Age: _____ Birth Date:___________ F/M _____; New School Year Grade ____
School District (new school year) ____________; School Name(new school year) _________; Year of learning Chinese: _______; How do you know us? ________
                                                                                   Parent/Guardian Information
 Mother’s Name:                                                                                          Father’s Name:
 Driver License #(for check payment purpose):                                                            Driver License #(for check payment purpose):
 Home address:                                                                                           Home address (if different):
 City                           Zip Code:                                                                City                            Zip Code:
 Home Phone:                     Work phone:                               Cell:                         Home #:                        Work #:                Cell:
 Employer:                                                                                               Employer:
 Email:                                                                                                  Email:
 Emergency Contact Name:                                    Phone:                                       Addr:                                      Relationship:
 Medical Insurance Name:                                    Medical ID:                                  Doctor Name:                               Phone:

 CYES Summer Chinese Curriculum: 1) Sunrise Chinese三锐中文www.oksunrise.org                  2) 绝色中文Yes! Chinese: www.yes.com.cn           3) 儿歌,童谣,成语故事
 Early bird rate: Enrollment before 4/15/09 can receive 5% discount (Discount rate only for the payment paid before 4/15/09. Any late added weeks are not eligible for this rate).
 CYES Summer Camp Application Fee (non-refundable)                         New Student:                        $100                                                                               $
                                                                           08-09 CYES school year students:    $25
 Camp Material Fee (non-refundable) Materials & equipments are             $100 (> 4 weeks); or $60(< 4weeks > 1 day);                                                                            $
 purchased upon your enrollment. It can’t be refunded even you withdraw
 A.Sunrise Chinese Camp (8:30am -- 4:30pm)                                 $268/week(New Beginner); $198/Week(Current Sunrise Book 6 only)
 New Beginner Sunrise Camp (8 weeks minimum) $268/Week                     1st Week         Session I           Session II       Session III         Session IV         Last Week    8/24(Mon.)
 三锐中文夏令营                                                                   6/15-6/19        6/22-6/26;          7/6-7/10;        7/20-7/24;          8/3-8/7;           8/17-8/21    Close        $
                                                                                            6/29-7/3            7/13-7/17        7/27-7/31           8/10-8/14         Day Care
 Current Sunrise Student Book 6 Camp $198/Week                             1st Week         Session I           Session II       Session III         Session IV  Last Week            8/24(Mon.) $
 三锐第六册夏令营                                                                  6/15-6/19        6/22-6/26;          7/6-7/10;        7/20-7/24;          8/3-8/7;    8/17-8/21            Close
                                                                                            现代综合 3-4            现代综合篇 8-9        现代经济篇 1-2           现代经济篇 6-7 Day Care
                                                                           现代综合篇            6/29-7/3            7/13-7/17        7/27-7/31           8/10-8/14  $188/week
 第六册:现代综合篇/现代经济篇                                                           1-2              现代综合篇 5-7          现代综合篇 10-11       现代经济篇 3-5          现代经济篇 8-10
 Extend care service: 4:30-6:30pm                                          $20/week; Free extend care for student who signs 8 weeks and up!                                                       $
 Sunrise System Learning Kits (New student)(Non-Refundable)                $280
(books, medias, language device for 3 years)
 B.Chinese Immersion Cultural Enrichment Camp                              $288/week; $864/One session
 (8:30am-4:30pm)
 中华文化育乐营(Chinese class+Cultural Theme activities+Field Trips)             Session I (3 weeks)          Session II (3 weeks)            Session III (3 weeks)             Last Week    8/24(Mon.) $
 (Please see Camp Schedule for the details)                               6/15-6/19;6/22-6/26;6/29-7/3 7/6-7/10;7/13-7/17;7/20-7/24;   7/27-7/31; 8/3-8/7; 8/10-8/14    8/17-8/21     Closes
                                                                                                                                                                        $188
 Extend care service: 4:30-6:30pm                                          $20/week; Free extend care for student who signs 8 weeks and up!                                                       $

 Total Amount Due: (One time payment is required. Each separate payment will be charged additional $5 process fee.)                                                                               $
                                                  1)   Any withdraw requires two weeks earlier written notice.
                                                  2)   Before 5/1/09, no withdraw fee required. Application fee is not refundable.
  Withdraw/Changing Policy:                       3)   During 5/1-6/12/09, Withdraw charge fee $100 (other than application fee);
                                                  4)   After 6/12/09 – before your sign up weeks, 80% tuition payment will be refund back;
                                                  5)   After your signed week starts, NO refund will be given back.
                                                  6)   Any change request will result $50 process fee. This includes change back to the original plan;
                                                  7)   One payment for entire summer camp is required. Each additional tuition check needs additional $5 process fee.




                                                              CYES Parent Agreement
 I, (name of parent/guardian) _________________ have read all attached CYES Statement and Policy, Tuition and Enrichment Fee Charge sheets. I agree to pay each month’s tuition/class
 fees and follow the school policies. I understand that failure to pay tuition/fees by required due date will result in termination from CYES. I have also agreed to sign the following
 liability release statements.
 I hereby authorize my signed child to participate all CYES indoor and outdoor program activities including annual events/parties, summer camp field trips and school year daily pick up
 assistance if parent has such need. I understand all camps’ filed trips and the pick up are organized on CYES/teachers/parents VOLUNTEER efforts. By signing this agreement, I do
 hereby release, forever discharge and agree to hold harmless to, CultureLinks Inc./Champion Youth Enrichment School, Saint Timothy’s Episcopal Church, Palo Alto Unified
 School District, Stratford School Inc. Car-pool driver, and their president, directors, administrators, teachers, contractor, employees/agents thereof from any and all liability, claims, or
 demands for personal injury, sickness, or death, as well as property damage and expenses or any nature whatsoever which may be incurred by the undersigned and the participant while
 said person is participating in the above described activities. The undersigned further hereby agrees to hold harmless and indemnify said school/corp./church, president, directors, teachers,
 contractors, employees/agents for any liability sustained by said acts of said participant, including expenses incurred attendant thereto.

 本人准許我的孩子________________________ 加入/參與 CHAMPION YOUTH ENRICHMENT SCHOOL 的一切室內外教學,課外文體活動和外游(field trips). 如意外事故發生, 學生家長不對 校方負責
 人, 教師﹐St. Timothy’s Church, Stratford School, PAUSD 和場所提供者追究任何責任. 我們並授權校方全權處理緊急醫療 情況,並同意支付所有醫療費用. 我们也同意遵守校方收费方法及其他 校
 规.


_________________________ (Parent/Guardian) Signature                                             ________________Date

				
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