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Mandarin Chinese - Online Registration

All fields with an asterisk(*) are required.

Parents' Information

Father's Name*
Mother's Name*
Email
Phone*
Address*

Child's Information

Number of children you want to enroll in the program:

Child 1

Child's Name*
Child's Birthdate*
Allergies/Additional Notes

Child 2

Child's Name*
Child's Birthdate*
Allergies/Additional Notes

Child 3

Child's Name*
Child's Birthdate*
Allergies/Additional Notes

Child 4

Child's Name*
Child's Birthdate*
Allergies/Additional Notes

Emergency Information

Emergency Contact Name*
Emergency Contact Phone*

Additional Information

Total due: $96 per month

How did you hear about this program?

How do you wish to pay?




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Phone: 842-5420