Chinese Academy of Cleveland Registration Form - Spring 2010 (A) Language and Culture Regular Classes: $160 for the first and $130 for the second registrations from the same family, and $110 each for the 3rd and beyond K-9th Grade (Class Code:K-9) & Pre-K (Class Code:PK; See Note #1) Chinese as a Second Language: $170 for the first and $140 for the others from the same family (material fee not included) Adults (A1, A2) & Children with ages from 6 to 8: (C1,C2,C3) (See Note #2) Special Classes: $75 for each class, besides S4($85) (See Note #3) Adults: (S1)Aerobics; (S2)Tai Chi; Children: (S3) Folk Dancing; (S4) Arts & Crafts: (S5) Martial Arts (See Note #3) Grade / Class Code English Name Chinese Name M/F Date of Birth PK,K-9 A1-2, C1-3 S1 S2 S3 S4 S5 Fee $160, $130 $170, $140 $75 $75 $75 $85 $75 $ $ $ $ $ (B) Registration Fee: US$10 Per Family (Waived if registered by December 31, 2009) $ 10.00 (C) Snack Preparation Deduction: Deduct US$30 Per Family if sign up for snack contribution (Note #4) $ Date: 1st preference ___________________ 2nd preference __________________ (D) Donation (Tax Deductible) $ (E) Total Payment $ Please make check payable to: Chinese Academy of Cleveland Send check with registration form to: Szewei Teng, 645 Dewitt Dr., Highland Hts., OH 44143 (F) Student Information Family E-mail Address: Address: Telephone(Home): City Zip Code £ New Address Parents (for minors) Chinese Name English Name Telephone (Cell) Father Mother (G) Emergency Contact Person Name:________________________________ Tel:______________ (H) Liability Release and Emergency Medical Treatment Authorization (Please initial each paragraph.) ______ We/I hereby release, discharge and agree to hold harmless Chinese Academy of Cleveland, its board members and staff, as well as Shaker Heights School and its staff and all persons acting under the permission or authority, from a liability whatsoever for any and all claims of any nature which may raise out of our/my attendance at the Chinese Academy of Cleveland, and/or purchase and / or consumption of food and / or snacks offered through the Chinese Academy of Cleveland during snack time, special luncheon, and special events sponsored by the Chinese Academy of Cleveland such as Chinese New Year Celebration, Outdoor Picnic, and End-of-Year Luncheon. This release covers us / me and any minor members of our/my family. ______ We/I hereby also agree on behalf of ourselves / myself and any minor members of our / my family to allow the staffs and board members of the Chinese Academy of Cleveland to release electronic or paper photographs of us / me and any minor members of our/ my family on published materials including newspaper articles, internet websites, and video / radio productions associated with the reporting and promotion of activities associated with the missions, actions, and activities of the Chinese Academy of Cleveland. ______ Furthermore, in case of emergency and my designated emergency contact cannot be reached, permission is granted to have my child treated by doctor or hospital appointed by the Chinese Academy of Cleveland or its authorized personnel." Signed by:__________________________________________ Date____________________ Note #1 Pre-K Class Rules and Regulations: Class Code: (PK) 1. Pre-K class is child-care oriented, not academic oriented. Time 2. Minimum 5 students and Maximum 10 students. 10:00-10:50,11:10-12:00PM 3. Age limit is no younger than 4 years old.(as the date January 1st, 2010) 4. No regular class contents will be taught in this class. 5. The Academy teachers' children have higher priority for admission so that the teachers can teach without distraction. 6. Parents are required to take turns in helping the class. 7. Fee and schedule are the same as regular language and culture classes. Note #2 Chinese as a Second Language Classes: Code Class Title Time (A1) CSL Adults 1 – Introduction 10:00-10:50,11:10-12:00PM (A2) CSL Adults 2 – Advanced 10:00-10:50,11:10-12:00PM (C1) CSL Children 1 – Introduction 10:00-10:50,11:10-12:00PM (C2) CSL Children 2 – Intermediate 10:00-10:50,11:10-12:00PM (C3) CSL Children 3 – Advanced 10:00-10:50,11:10-12:00PM 1. This program is specifically designed for students from non-Chinese speaking background. 2. For children program a parent must sit in the class to assist his/her own child(ren). 3. Minimum - 5 students / Maximum – 12 students. Continuing students have reserved slots until Dec, 31, 2009. The remaining slots will be filled on a first come first serve basis. 4. Age limit for Children classes' new students are from 6 to 9 years old.(as the date January 1st, 2010). New students are assigned to classes based on their Chinese language ability. 5. Decisions may be made by the Academy to cancel the program due to lack of student enrollment. Note #3 Special Classes Students who meet the age requirement are encouraged to elect special classes to broaden their knowledge and experiences of Chinese culture. The Academy may cancel a class due to lack of enrollment or teaching faculty. So register early to increase the availability of a class you desire! Code Class Title Time (S1) Aerobics (Adults) 10:00 - 10:50AM (12 Classes) (S2) Tai Chi (Adults) 11:10 - 12:00PM (12 Classes) (S3) Folk Dancing (Ages 6-12, Max. 12 students. Continuing students have reserved spots 12:10 - 1:00PM (12 Classes) until December 13, 2009.) (S4) Arts & Crafts (Ages 7+) ($10 material fee is added) 12:10 - 1:00PM (12 Classes) (S5) Martial Arts for Children 12:10 - 1:00PM (12 Classes) Note #4 Snack Preparation It has been our tradition to offer a snack break between first and second class periods. Our students, teachers, and parents enjoy the delicious snacks while having a chance to socialize. A $30 fee has been included as part of the registration fee for this purpose. However, we strongly encourage families' involvement. If you are able to contribute snacks (about 30 servings) one time during a school semester, you can deduct $30 from the registration fee. Thank you for your cooperation support. * Please refer to http://www.chineseacademyofcleveland.org for latest school information.