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Registration Information for New Student with New Family

Family Details
Family Name(Student Last Name):*
Contact Person's Email:**
Contact Person's Phone
(xxx-xxx-xxxx) :***
Address:
City:
State:
Zip Code:
Second Phone
(xxx-xxx-xxxx) :
Other Phone
(xxx-xxx-xxxx) :
Mother Name:
Father Name:
Student Details
Student First Name:
Student Chinese Name:
Date of Birth
(YYYY-MM-DD):
Gender: Male Female
Chinese Class: Chinese Classes Information
Culture Class: Culture Classes Information
Note: * please input parent/guardian last name in family name input area, put your last name for adult students.
Note: ** please input parent/guardian email in contact person's email input area for children students, put emergency contact email for adult students.
Note: *** please input parent/guardian phone number in contact person's phone input area, put emergency contact phone number for adult students.

Release of Liability Statement
  • In consideration of the activities at the Broadview Middle School Sponsored by Huaxia Chinese School at Connecticut, a non-profit organization, it is understood and agreed that said Huaxia Chinese School or its officials, teachers, or volunteers will not be held responsible for missing of child, any injury, accident, sustained by the member of our party, or for the loss of or damage to any property belonging to a member of our party or anyone else.
  • I give permission to Huaxia Chinese School of CT using pictures taken during school event or class time for school brochure or news release purposes.
    • I have read and accepted the above release of liability statement and all HuaXia Chinese School at Connecticut Policies and Rules and Student Code of Conduct.





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