(If you prefer us to refer your child in his or her Chinese name, please let our teachers know)
First Child’s Name: Chinese Name:
Birth date: Location:
Level of Mandarin Understanding:
Favorite Activities:
Second Child’s Name: Chinese Name:
Birth date: Location:
Level of Mandarin Understanding:
Favorite Activities:
Third Child’s Name: Chinese Name:
Birth date: Location:
Level of Mandarin Understanding:
Favorite Activities:
Please kindly describe to us students Mandarin levels:
Email Address:
Tel. number:
How do you hear about us?
Please make your check payable to Mandarin Together, Fun.
Please send the check to P.O Box 1168, Hoboken, NJ 07030-1168
Your spot will be reserved once we received your payment.
$30 charges for bounce check.
Please fill out the Contact Info below.
Mother Name: Email address:
Cell Phone: Home/Office Phone:
Home Address:
Father Name: Email address:
Cell Phone: Home/Office Phone:
Home Address:
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Pediatrician Name: Phone:
Address:
Any allergies and medical conditions:
Emergency contact Name and Phone:
Authorized adult to pick up Name and Phone:
Authorized adult to pick up (relationship with the child):
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