2005-2006 學年度印城華人基督教會中文學校招生

Chinese School of Chinese Community Church of Indianapolis

www.indychinesechurch.org/school/index.htm

一‧開學日期School starting date：January 21, 2006 at 9:30 AM

二‧上課時間Time： 9:30 AM- 12:00 PM, Every Saturday

三‧上課地點Place：Chinese Community Church of Indianapolis

                   3405 E 116 street Carmel, IN 46033   (317)706-0433

四‧預開班級Classes plan to open：(新生需出示出生證明)

Kindergarten                 (新生需於9/1/2005前滿五歲) (New student must be 5 years old before 9/1/2005)

正三班  Traditional 3   

正四班  Traditional 4   

正五班  Traditional 5   

正六班  Traditional 6   

簡一班  Simplified 1    (新生需於9/1/2005前滿六歲) (New student must be 6 years old before 9/1/2005)

簡二班  Simplified 2    

簡三班  Simplified 3    

簡四班  Simplified 4    

簡五班  Simplified 5    

簡六班  Simplified 6       

七年級  7 grade        (combined simplified traditional)

八年級  8 grade       (combined simplified traditional)

** 班級須滿五人以上才開班，最多二十人為限。不足五人之班級，將併班或停班。

(Class students:  minimum:5  maximum:20 )

五‧註冊費用Tuition and Parents’Duty deposit：

a. 每學期學費Tuition: 1人-$135  2人-$260  3人-$385  (包含學費、點心、課間活動費)

在校生須於 1/21/2006前完成下學期註冊手續，逾期加收十五元補註冊費。( 因學校須確知學生

人數才可安排開班及聘請老師，請家長務必配合。所收學費支票將於下學期開學後兌現。)

Return students must complete registration before January 21, 2006.  After that, a $15.00 late fee will be required.

b. 家長輪職保證金The Parents’ Duty deposit: $50

每一家庭於註冊時需繳家長輪職保證金$50，分寫成兩張 $25支票。凡完成一次輪職任務，

由輪職組長退還 $25保證金，一學期輪職兩次。若家長輪職缺席，則保證金不退還。

**一學期家長輪職兩次，一學年共輪職四次。

六‧報名表

每一家庭填寫一份報名表，支票抬頭請寫: CSCCCI

請將報名表及支票交給班級老師或寄至   Brenda Lin , 1367 W. Kirklees Dr.  Carmel, IN 46032

七‧如有任何問題請與仲伯禹(317-581-1712)或張为华(317-569-8425)聯絡。

 If you have any question, please call Boyu Zhong(317-581-1712) or Brenda Lin (317-569-8425).

2005-2006學年度第2學期

印城華人基督教會中文學校註冊表格

Chinese School of Chinese Community Church of Indianapolis Registration Form

3405 East 116 th street, Carmel, IN 46033     (317)706-0434

www.indychinesechurch.org/school/index.htm

學生資料Student Info:

     English                      Chinese                    Original       New      Return    speak         Sex              Date of

      Name                        Name                      Class           student   student  Mandarin                         Birth

家長資料Parents Info:

                     English Name             Chinese Name        Profession              E-mail Address

Father:

Mother:

Address:

Home Phone:                                                         Emergency Phone:

‧每學期學費Tuition:  1人-$135   2人-$260   3人-$385  (包含學費、點心、課間活動費)

‧ 每一家庭應繳家長輪值保證金: $50，請分寫兩張$25支票。若已確定無法輪值，可寫一張$50支票，並註明無法參加輪值，保證金由學校運用。

The Parents’ Duty deposit: $50 is required at the time of registration ,please write two $25 checks.

‧ 支票抬頭請寫CSCCCI，請將報名表及支票交給班級老師或寄至

Please make check payable to: CSCCCI, and hand the registration form to classroom teacher or mail the registration form to following address:  Brenda Lin   1367 W. Kirklees Dr.  Carmel , IN 46032

‧ 各欄務必填寫清楚，否則將視為註冊手續未完成。

‧ 在校生請於1/21/2006之前完成註冊手續，逾期將收取十五元補註冊手續費。

‧ 退費標準：扣除手續費$10，開學四週內每週扣學費$10，四週後恕不退費。

I/We                                         parent/guardian of                                                     hereby release, discharge

and agree to hold harmless the Chinese School of Chinese Community Church of Indianapolis, its representatives or assign and all persons acting under its permission or authority from any liability whatsoever for any and all claims of any nature which may arise of out of our attention including myself/ourselves and our minor(s) at the above said school during the school year. This release covers myself/ourselves and any of my/our family members.

家長或監護人簽名parents or guardian signature                                日期 date

        PARENTAL CONSENT AND MEDICAL INFORMATION FORM

學生健康資料 Student’s Health Info:

Heath History:                               Disease:      

中耳炎Frequent ear infections                             水痘Chicken Pox

心臟缺陷/疾病Heart defect/disease                 麻疹Measles

抽慉Convulsions                                     德國麻疹German Measles

糖尿病Diabetes                                       腮腺炎Mumps

流血不止/血凝塊Bleeding/Clotting Disorders               氣喘Asthma

破傷風Tetanus                                 其他 others

Allergies:                         

毒藤Poison ivy, etc.              

花粉熱Hay fever                                    

昆蟲叮刺Insect Sting

盤基西林Penicillin

其他藥物Other drugs (please list)

有任何我們需要特別注意貴子弟的健康情形嗎？請寫出。

Is there any medical information you feel we should have concerning your children?      

醫生姓名 醫生電話

Name of Physician:                                             Physician’s Phone:                     

保險公司名稱 保險號碼

Insurance Name:                                                  Carrier Policy or Group#:

I authorize any representative of the CSCCCI to seek medical attention for my children when immediate medical care is warranted by the circumstances and I cannot be reached, or if under  the circumstances there is no time to attempt to reach me because of the nature of the injury or illness. I further authorize the health care professional selected by the CSCCCI to provide necessary care and treatment to my children, in which case all such expenses shall be paid for by me. I shall in no way hold CSCCCI or its representatives responsible for any financial obligation.

家長或監護人簽名parents or guardian signature                                日期 date

WAIVER, RELEASE OF LIABILITY, AND CONSENT TO MEDICAL ATTENTION

Chinese School of Chinese Community School of Indianapolis

3405 E 116 Street, Carmel, IN 46033

 NAME:

ADDRESS:

HOME PHONE:

EMERGENCYPHONE:

 In exchange for my child(ren) being allowed to participate in events sponsored by the Chinese School (herein referred to as “CS”), I agree to be bound by each of the following:

1. Obligation to Inspect Facilities and Equipment. I agree that prior to participating in the event, I will inspect the facilities and equipment to be used. If I believe anything is unsafe, I will immediately advise the supervisor of the event and CS staff of such unsafe condition(s) and refuse to participate in the event.

2. Identification of Risks. I understand the participation in the event may involve risk of serious injury, including permanent disability and death, and other losses, both to persons and property. I understand that these injuries and losses might result tram the actions, inactions, negligence, or conduct of others, the rules of the event, or the condition of the premises or of any equipment used.

3. Assumption of Risk. I assume all risks, known and unknown, in any way connected with my child’s participation in the event I accept personal responsibility for any liability, injury, loss or damage in any way connected with my child’s  participation in the event

4. Waiver and Release. I waive, release, and hold harmless CS and its staff, teachers, the church,  volunteers, from all claims for any liability, injury, loss or damage in any way connected with my child’s participation in the event, whether or not caused in whole or part by the negligence or other misconduct of CS or any of the persons mentioned above. I intend for this waiver and release also to apply to any relatives, personal representatives, heirs, beneficiaries, next of kin or assigns who might pursue any legal action or claim for such liability, injury, loss or damage.

5. Consent to Medical Treatment. I agree that CS may provide to me, through medical personnel of its choice, customary medical or training assistance, transportation, and emergency medical services. This consent does not impose a duty upon CS to provide such assistance, transportation, or services.

I HAVE READ THIS WAIVER, RELEASE, AND CONSENT. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM SIGNING THIS WAIVER, RELEASE, AND CONSENT VOLUNTARILY.

Signature

Printed Name