Chinese Story Telling Competition
Registration
Contact Information
Parent/Legal Guardian Name:
Contact Phone (Primary):
Contact Phone (Secondary):
Street/Apt:
City:
State:
Zip:
Email (Primary):
Email (Secondary):
Student Information #1
Student English Name:
Student Chinese Name:
Student DOB:
Born in US: Yes/No?
Native Chinese Speaker:
Yes/No?
Years in USA?
Regular School Grade:
Chinese School Grade:
Student Information #2 (if applicable)
Student Name:
Student Chinese Name:
Student DOB:
Born in US: Yes/No?
Native Chinese Speaker:
Yes/No?
Years in USA?
Regular School Grade:
Chinese School Grade:
Student Information #3 ((if applicable))
Student Name:
Student Chinese Name:
Student DOB:
Born in US: Yes/No?
Native Chinese Speaker:
Yes/No?
Years in USA?
Regular School Grade:
Chinese School Grade:
IT IS UNLAWFUL FOR ANY PERSON TO KNOWINGLY OBTAIN OR DISCLOSE PERSONAL
INFORMATION FROM POTOMAC CHINESE SCHOOL RECORDS EXCEPT AS AUTHORIZED
BY THE BOARD OF POTOMAC CHINESE SCHOOL. IT IS ALSO MUTUALLY UNDERSTOOD
AND AGREED THAT POTOMAC CHINESE SCHOOL CAN ONLY USE MY PERSONAL
INFORMATION SOLELY FOR THE PURPOSE OF "STORY TELLING COMPETITION
I, THE UNDERSIGNED, DO HEREBY AFFIRM THAT I HAVE READ AND UNDERSTAND THE
ABOVE STATEMENT AND AGREE TO ABIDE BY ALL LAWS, TERMS AND STIPULATIONS
CONCERNING THE DISCLOSURE OF PERSONAL INFORMATION CONTAINED IN POTOMAC
CHINESE SCHOOL RECORDS.
Signature: __________________________________
Date: ____________