Register Online - Champion Chinese Immersion Preschool - CHAMPION EDUCATION

2018-2019 Preschool Registration Form

* Indicates required field

Student Name *

First

Last

Birth Day *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Chinese Name *

Gender *

Male Female

Insurance Infomation (Provider & Policy Number) *

Allergy / Medical Infomation *

Father's Name *

First

Last

Email *

Phone Number *

Mother's *

First

Last

Email *

Phone Number *

Desired Start Date (For Late Starters) *

Days / Week *

one month's notice agreement

I acknowledge that a one month's notice is required to withdraw from the program or non-attendance. If a one month's notice for early withdrawal is not given, your deposit will not be refunded in any forms unless the deposit will be used towards your child’s account balance as credits. There is no reduction in fee for non-attendance without an one month's notice. *

I agree

Question or Comment *

Submit