Kissimmee Chinese School

Registration Form
Year: Fall - 2008

Student Information

Last Name:

First Name:

Chinese Name:

Birthday:

Gender:

New Student:

Female Male

Yes No

Street Address:

City:

State:

Zip Code:

Home Phone:

Father / Guardian

Last Name:

First Name:

Chinese Name:

Mother / Guardian

Last Name:

First Name:

Chinese Name:

Emergency Info

Emergency Contact Name:

Emergency Contact Phone:

Dr.'s Name:

Dr.'s Phone:

Tuition & Schedule

Chinese Language Class (14:00 - 16:30)

Youth Elective Classes
(Tuition: $30/per class; Minimum 5 students per class)

Adult Elective Classes
(Tuition: $40/per class; Minimum 5 students per class)

Payment Options

We accept payment from American Express, Visa, Mastercard, and Discover through
PayPal (you do not have to have a PayPal Account)

Submit this form first, and you will be taken to the payment page.