Chinese Dragon Camp

The Future Speaks Chinese

BANGOR CHINESE SCHOOL

Student Summer Program Registration Form (Monday-Friday, 9:00-4:00, June 26 –July 14, 2017) Student’s Name: ______D.O.B______Gender: ______School: ______Grade: ______Email:______Student’s Address: ______City: ______State: ______Zip: ______Food Allergy? ______Will the child wish to be housed in the residence hall during the summer session? Yes____ No______(Note：Students who live in 50 miles away have priority to be housed) If yes, will the child stay the dorm during the weekends? Yes ($250/weekend) ______No_____ (Note: Weekend activities will be scheduled, like, Chinese speaking, writing and singing contests, field trips or sport games...) Does the child need a uniform (traditional Chinese silk cloth: $30/each)? Yes (Size:_____) No ______Name of Parents/Guardian: ______Home Phone: ______Work Phone: ______Cell Phone: ______Email: ______Emergency Contact Name: ______Phone: ______Cell Phone: ______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? ______Does your child want to take Chinese lessons (online is available at BCS) now? Yes ______No______Will your child sign a three-week CLCCM/HANBAN Study in China program on 7/17-8/5? 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:______I learned of the STARTALK Summer 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 Other (please specify): ______I would like to receive information for my child about: Chinese Lessons (face to face or online) 2018 Travel Study in China YCT/HSK Test

[1] Payment (if applicable) included? Yes $______No (Reason:______)

Signature: ______Date: ______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 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.

[2] Signature of Parent/Guardian: ______Date______

Please return to: BANGOR CHINESE SCHOOL 53 Cumberland Street, Bangor, ME 04401

[3] 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 26-July 14, 2017. 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 20, 2017.

Student’s name:______

Your name and title:______

How long have you known this student, and in what capacity?______

______

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 other responsibilities?)

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. [4] Thank you.