CANTON CHINESE SCHOOL
Online Registration

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Canton Chinese School Registration Form

Student Information

First Name
Last Name
Student ID
Chinese Name
Gender
Male Female
Date of Birth
Home Address
City
State
Zip Code
Home Phone
Previous Grade
Current Grade
Class to Register
Culture Class

Father Information

First Name
Last Name
Chinese Name
Work Phone
Email

Mother Information

First Name
Last Name
Chinese Name
Work Phone
Email

Emergency Contact Information

Medical Insurance
Policy #
Doctor's Name
Doctor's Phone

Persons Other Than Parents to Contact In Case of Emergency

Name
Phone
Name
Phone

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