When filling out the form, please do not use the comma (,) character. Thank you |
Student Info: |
Registering new student? * |
Yes
No
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| First Name:* |
M.I.:
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| Last Name:* |
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| Date of Birth (mm/dd/yyyy):* |
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| Registering for Chinese Classes?* |
Regular Class (2hr)
FCC (1hr) No |
| Student E-mail: | |
| Extension Class: |
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When you have filled out the information, press the "Add Student" button to add the student to the list.
If you have made a mistake, please select that student in the list,
click remove and re-input his/her information
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| Parent/Guardian Info: |
| First Name:* |
M.I.: |
| Last Name:* |
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| Address:* |
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| City:* | |
| State:* | |
| Zip Code:* |
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| Phone Number:* |
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| Alternate Phone Number: | |
| Your E-mail:* |
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| Spouse E-mail: | |
| Parent Committee |
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| Emergency Contact Info: |
Phone Number(cell, pager, etc.),
or where you can be found:* |
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| Donation Info |
If you would like to make a donation,
how much would you like to donate: |
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You MUST agree to the following before submitting your request!
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By submitting this form, I hereby release the Chinese School
at IUPUI from any medical expenses which my child/children may
incur as a result of participating in the normal course of the program.
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