BANGOR CHINESE SCHOOL (BCS)/CLCCM - Chinese Dragon Camp 100% Immersion Chinese Language Learning Experience Registration Form (Monday-Friday, 9:00-3:00, June 28 –July 16, 2021) Personal Information: Student’s Name: ______D.O.B______Gender: ______Food Allergy? _____ School: ______Grade: ___ Email:______Phone/Wechat______Student’s Address: ______City: ______State: ______Zip: ______
Parents Information: Name of Parents/Guardian: ______Home Phone: ______Work Phone: ______Wechat (if applicable)______Cell Phone: ______Email: ______Emergency Contact Name: ______Phone: ______Cell Phone: ______Wechat (if applicable)______
Each child is expected to attend the whole program (three weeks): Yes____No____but if no, please specify the weeks the child signs up for: ______and we will do our best to accommodate. Will the child wish to be housed in the residence hall during the summer session? Yes__if yes, how many weeks?__ No_ (Note：Students who live 50 miles away have priority to be housed)If yes, will the child stay in the dorm during the weekends? The cost is $295/weekend. Yes ____If yes, how many weekends?______No_____(Note: To ensure maximal benefit for residential children, weekend activities will be scheduled as well, like Chinese speaking, writing and singing contests, cooking, field trips or sport games...). Does the child want to earn 3 college credits ($495)? Yes___No__ Does the child need a uniform (traditional Chinese silk cloth for M & F to wear: $30/each)? Yes (Size:_____)No ______Does the child need learning materials: text book and workbook ($50-70 depends on class level)____dictionary $60_____
Does your child require special care? Yes __No__; may we call you to make arrangements? Yes ____No____ Does your child need before or after care? Yes (please specify) ______No____ Child’s previous Chinese Lessons: Yes ___No ____If yes, how long? ___;did the child ever take tests (please circle) ? YCT, HSK, The Seal of Biliteracy, AP or Sat Subject, OR want to take any of the tests: Yes (please specify) _____No___ Does your child want to take pre-program Chinese lessons (online is available at BCS)? Yes ______No____
Has the child been to China? Yes _____No _____ If yes, when?______how long? ______where?______Will your child sign up for a three-week CLCCM/BCS Study in China program on 7/20-8/5? Yes______No______
Please list any adults or relatives that are authorized to pick up your child. Be aware that a child will not be released to those who are not listed here or not listed as parent/guardian unless prior contact is made. Name: ______Relationship:______
Do your family plan to attend our closing ceremony (July 16th at 3 pm)? Yes_____No_____; and do you want to have the recording of videos/pictures as special memory by the end of the program ($45)? Yes_____if yes, how many___ No____
I learned of the Summer Immersion Camp from:______
My child’s motivation to attend the program is the result of: Personal Growth Education Family Heritage General Interest Career Interest Travel Plans I would like to receive information for my child about: Chinese Lessons (in person or online) 2022Travel Study in China YCT/HSK/The-Seal-of-Biliteracy Test
***Spaces are limited so first come and first serve will be applied. Limited needed-based scholarship is available.
Weeks Day-Camp Overnight/Residential Dates Program Three (3) Weeks $795 $1795 Before 5/25/21 M-F Cost $2095 After 5/25/21
Two (2) Weeks $695 $1595 Before 5/25/21 M-F $1795 After 5/25/21
I would like to pay by check______, Venmo (ID: Jing-Zhang-193)______, or other (Please specific)______
Payment included with the form: Non-Refundable Registration Fee ($55)______Program Fee $______other amount: $______
Signature: ______Date: ______Register with confidence; we never cancel classes! NOTE: 1.NO REFUNDS WILL BE GIVEN AGTER JUNE 7, THREE WEEKS BEFORE THE PROGRAM BEGINS. [1]
PERMISSION TO USE LIKENESS
I give Bangor Chinese School permission to use, publish and republish my likeness for the purpose of promoting Bangor Chinese School.
( ) I also give permission for Bangor Chinese School to publish/republish my name to accompany my likeness.
( ) I refuse to give Bangor Chinese School permission to publish my name in any way.
( ) I refuse to give Bangor Chinese School permission to publish or republish my likeness in any manner.
Child’s Name:______
Signature of Parent/Guardian:______
BANGOR CHINESE SCHOOL FIELD TRIP PERMISSION
I consent and agree that my child, ______(name), may participate in any field trips ((like trip to Acadia National Park, July 4th Parade, Chinese Community and other places), swimming and other activates outside campus sponsored by Bangor Chinese School. I understand that transportation will be provided by Bangor Chinese School and its staff. I further understand that I will be notified by the Bangor Chinese School teachers at least a day in advance of planned field trips. I do understand, however, that occasional unplanned, short walking expeditions may come up, at which time I may or may not be notified in advance.
I will not hold Bangor Chinese School or its employees responsible for any injury to the above-named child resulting from transportation to and from and attendance at the above field trips.
Signature of Parent/Guardian: ______Date______
EMERGENCY MEDICAL & COVID-PEOTOCOLS CONSENT FORM
Bangor Chinese School has my permission to obtain emergency medical treatment with its on call doctor for my child, ______when I cannot be reached or if a delay in reaching my child would be dangerous for him/her. I understand that I assume all my financial responsibility for any treatment or injuries sustained by my child while he/she is in the Bangor Chinese School.
I agree that my child ______may be required to wear a mask, keep distance, wash hands and follow other Covid-19 protocols by BCS (if needed by then).
Signature of Parent/Guardian: ______Date______
Please return to: BANGOR CHINESE SCHOOL 5 Woodview Dr, Bangor, ME 04401 OR Email to: [email protected]
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Note: Only for students who are new to the Bangor Chinese School
TEACHER RECOMMENDATION
Dear Teacher: please tell us about the applicant, who is interested in Bangor Chinese School’s STARTALK program, a summer Chinese language camp during June 28-July 16, 2021. This program is selective and intensive; therefore, participants must be enthusiastic about language, culture and prepared for a rigorous pace of learning. We ask that you consider these requirements as you prepare your recommendation. Thank you.
To ensure confidentiality, please place the completed form in a sealed envelope, sign your name across the sealed area and return it to the applicant at your earliest convenience. The application deadline is May 1, 2021.
Student’s name:______
Your name and title:______
How long have you known this student, and in what capacity?______
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Please consider and comment on the following, rating this student on a scale of 1 - 5.
Poor Below Average Fair Good Excellent 1 2 3 4 5 Attendance (Is student missing class or is tardiness a problem?) Integrity (Does this student produce work honestly) Reliability (Can this student be relied upon to complete assignments and otherresponsibilities?)
Participation in Class (Does this student contribute to class discussions and projects?) Academic Achievement (Does this student work to his or her potential?) Emotional Readiness (Do you feel that this student has the emotional readiness for this kind of program?)
It is preferred that this recommendation be written by a foreign language teacher; however, any teacher from the applicant’s school is welcome to make the recommendation.
Please attach any additional comments to this form. Thank you.
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