"WinterSpring 2009 Registration Form - Nashua Campus Only"
Winter/Spring 2009 Registration Form - Nashua Campus Only – Saturday Day Div. STUDENTS M(Male)/ Last Name First Name F(Female) Date of Birth Age Class (see Programs/Class Schedule) Mailing Address City/Town State Zip Email Address Phone # Would you like to be a volunteer? Yes ________ No ________ Emergency Contact Name Emergency Phone # Where did you hear about our school? (Please be specific) For students under age 18: (Please indicate the phone# if it’s different from the student’s.) Father’s name Phone or cell # Mother’s name Phone or cell # Tuition ($480 per adult/teen I-IV student; all other levels are $320; textbooks, exercise note books, snack, drink $ are excluded.) x ____ of students $ + Registration Fee ($20 per student ) x ____ of students $ + Donation $ = Total Amount (payable to NH Chinese School) (Insufficient fund on returned check will be charged for $35.00 each) Please mail the completed form and payment to NH Chinese School, P.O. Box 80, Londonderry, NH 03053 Phone # 1-888-262-1993 Cancellation & Refund Policy: Cancellation made on 2nd week of school is entitled to 50% refund. Afterwards, no refund is allowed. Registration fee is not refundable. **All classes are subject to minimum enrollment determined by the school Board** The shaded area is reserved for administration use only: Check # _________ Check Date # __________ Amount $ __________ Receiver Initial ________ Date: ____________ Programs: Preschool Mandarin Playgroup (expected ages 3 to 5) offers children who are not yet ready for structured lessons a chance to learn spoken Mandarin through songs and games, and participate in activities and stories to learn about Chinese language & culture. Elementary Mandarin I or Cantonese I offers school aged children the opportunity to learn spoken either language through books, games and activities. Some character writings will be introduced. These two classes are for beginners. Level II is also available. Adult/Teen Beginner’s Mandarin I class is intended for students who wish to learn spoken and written Mandarin. Some character writings will be introduced. It is intended for the beginners. Level II and III are also available. Adult/Teen Intermediate Mandarin I class is intended for teenagers or adults who speak, read, and write some Mandarin and are interested in extending their skills through different projects as well as traditional study. Immersion Mandarin I (Elementary or Adult/Teen) The total immersion experience method will allow students to have plenty of opportunities to practice the target language they are learning inside of the classrooms and outside of classrooms with specific assignments. We provide a supportive Chinese speaking environment conducive to learning the language. http://www.NHChineseSchool.org 1 Class Schedule: 9:10 AM – 11 AM or 11:20 AM – 1:10 PM, Saturday School Phone: 1-888-262-1993 School Location: Girls’ Inc., 27 Burke St., Nashua, NH 03060 (Cross roads: Main St. & Allds St.) (For directions to the school, check our web site @ www.nhChineseSchool.org) 2008 (Winter/Spring Semester) Class Time Feb 7 14 21 Preschool Mandarin Playgroup 9:10 am-11 am 14 Mar 7 21 28 9:10 am-11 am Elementary Immersion Mandarin I or II Apr 4 11 18 Adult/Teen Immersion Mandarin I 9:10 am-11 am Cantonese 11:10 am–1 pm May 9 16 23 30 Adult/Teen Mandarin I-IV 11:20 A –1:10 P Jun 6 Elementary Mandarin I or II 11:20 am-1:10 P Adult/Teen Mandarin I or II or Intermed 11:20 am-1:10 P ** No inclement weather make-up Open House & on-site Registration: Feb. 7, 2009 at Nashua school, 10 AM – 12 PM or mail in registration to school PO Box 80, Londonderry, NH 03053 to reserve a space. RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT IN CONSIDERATION of being permitted to utilize the facilities, services and programs of NH Chinese School for any purpose, including, but not limited to observation or use of facilities, equipment or materials, or participation in any offsite program affiliated with NH Chinese School, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into NH Chinese School for observation or use of any facilities, equipment or materials or participation in such affiliated program constitutes an acknowledgment that such premises and all facilities, equipment or materials thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE NH Chinese School, its directors, officers, employees, sponsors, consultants, volunteers, property owners and their respective agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any photo or video taking, any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, or about the premises or any facilities, equipment or materials therein or participating in any program affiliated with NH Chinese School. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage or cost they may incur due to the negligence, intentional act or other contributory act of the undersigned or such children in, upon or about NH Chinese School premises or in any way observing or using any facilities, equipment or materials of NH Chinese School or participating in any program affiliated with NH Chinese School whether caused by the negligence of the releasees or otherwise. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such children due to the negligence of releasee or otherwise while, in about or upon the premises of NH Chinese School and/or while using the premises or any facilities, equipment or materials thereon or participating in any program affiliated with NH Chinese School. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of New Hampshire and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made. For all students under the age of 18: CONSENT AND RELEASE OF PARENT OR LEGAL GUARDIAN: I am the parent or legal guardian of my children indicated in the registration form. I consent to my Children’s participation in NH Chinese School. I HAVE READ AND UNDERSTOOD the RELEASE AGREEMENT. In consideration of allowing my Child or Children to participate, I agree that THE TERMS OF THIS RELEASE SHALL LIKEWISE BIND ME, MY CHILDREN, my heirs, legal representatives, and assignees. I HEREBY RELEASE AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM EVERY CLAIM AND ANY LIABILITY that I or my Children may allege against the Releasees (including reasonable attorney’s fees or costs) as a direct or indirect result of injury to me or my Children because of my Children’s participation in the programs, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE RELEASEES or others. I PROMISE NOT TO SUE RELEASEES on my behalf or on behalf of my Children regarding any claim arising from my Children’s participation in the programs. Adult student/Parent/Guardian Signature: ______________________________________ Date: _________________ , 200_ Notice of Nondiscriminatory Policy to Students New Hampshire Chinese School admits students of any race, color, nationality and ethnic origin. It does not discriminate on the basis of race, color, nationality and ethnic origin in administrating its educational policies, admissions policies, scholarship and loan programs, and other school-administered programs. http://www.NHChineseSchool.org 2