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Use the form on the right to contact Mid Jersey Chinese School.

18 Norton Rd.
East Brunswick, NJ 08816
USA

732-707-1191

Mid-Jersey Chinese School provides Mandarin and Cantonese Chinese language education to central New Jersey. Offering classes for children of preschool to high school ages and adults.

On-Line Registration Form (test)

CACA - MID-JERSEY CHINESE SCHOOL

2015-2016

學年班註冊申請
Registration Form

Parent Information 家長資料
Father's Name 父親姓名
Father's Name 父親姓名
Mother's Name 母親姓名
Mother's Name 母親姓名
Address 住址 *
Address 住址
Home Phone 電話 *
Home Phone 電話
Cell Phone 手機
Cell Phone 手機
Emergency Contact 緊急聯絡人 *
Emergency Contact 緊急聯絡人
Emergency Phone 緊急聯絡電話 *
Emergency Phone 緊急聯絡電話
Student's Information 學生資料
Student's Name 學生姓名 *
Student's Name 學生姓名
Student's Birthday 學生生日 *
Student's Birthday 學生生日
(Optional classes available from 11:30AM~12:30 PM)
Student's Name 學生姓名
Student's Name 學生姓名
Student's Birthday 學生生日
Student's Birthday 學生生日
(Optional classes available from 11:30AM~12:30 PM)
Student's Name 學生姓名
Student's Name 學生姓名
Student's Birthday 學生生日
Student's Birthday 學生生日
(Optional classes available from 11:30AM~12:30 PM)
$
Helping with School Activities 參與學校活動 *
(Every Family has to select at least two events) (每家庭至少要選兩項)
CONSENT and RELEASE *
The undersigned whose name printed below, hereby explicitly releases the Mid-Jersey Chinese School, its board of directors, principal, teachers and administrators from any liabilities including but not limited to personal injury, loss of properties and any damages associated with the student(s) whose name(s) listed below, attending the Mid-Jersey Chinese School and/or participating any of the school activities. The undersigned hereby consents to be held personally responsible for any damages resulting from the student’s conduct while attending the Mid-Jersey Chinese School and/or participating any of the school activities. It is understood that if student is enrolled in any physical activities like but not limited to yo-yo, kung-fu, or dance, various injuries may occur. I also understand that it is my responsibility to make sure my child is physically capable of participating in these programs and a physical exam by a doctor is recommended. I verify the address below is the permanent residence of the named students and that all the information stated below is, to the best of my knowledge, true and correct. Any intentional falsifying of information will result in automatic expulsion of my child/ward from the school/program. I agree to abide by all rules, regulations, and policies as set forth by the Mid-Jersey Chinese School and teachers/coaches. East Brunswick Township and the Board Of Education is not a sponsor of any activity and are held harmless. Unless otherwise requested in writing and approved by Principal for good cause, the undersigned further consents to complete school assigned safety duties. In the event that the undersigned is not able to complete the safety duties when called upon, the undersigned agrees to be billed a $50.00 penalty. Please see “School Safety Duty and Rules” for details.