<p> 2015 Hutong Mandarin Learning Summer Camp Application Form For 2015 Hutong Mandarin Learning 501, 5/F, Blue Castle International Center II, West Dawang Rd., Beijing, China E-mail: [email protected] Tel: +8610-85999839 REGISTER ONLINE! www.edutripintl.com ______Thank you for your interests in applying to Edutrip International Hutong Mandarin </p><p>Learning Summer Camp. Please provide information below in English or Chinese.</p><p>All applications are handled confidentially.</p><p>Camper Information Camper’sName______Nickname______</p><p>Chinese Name______(If any) City______</p><p>Gender______Male______Female______Birthday (DD/MM/YY) ______</p><p>Nationality______Passport No.______Passport Expiration Date______</p><p>Your Height Your weight (Make sure your size of Camp T-shirt)</p><p>E-mail Address ______Tel______Fax______</p><p>School Name______Grade______T-shirt Size______</p><p>Camp’s Year-round Address______</p><p>Camper’s Mandarin Proficiency 1. Have you ever learned Chinese? 2015 Hutong Mandarin Learning Summer Camp</p><p>Yes </p><p>No</p><p>2. How do you learn Chinese?</p><p>One on one Chinese tutor </p><p>Chinese language course offered by school</p><p>Chinese course offered by language institution</p><p>3. Your Chinese teacher’s name ______</p><p>Please offer your Chinese teacher’s E-mail if possible (We may need to contact</p><p> your Chinese teacher for the information) ______</p><p>4. Your Chinese level</p><p>Zero </p><p>Basic </p><p>Intermediate </p><p>Advanced</p><p>5. Have ever been to China before?</p><p>Yes</p><p>No</p><p>If yes, where have you been in China? ______</p><p>Parent/Guardians at Camp’s Permanent Address Parent/Guardian 1</p><p>Name______Relationship to Camper______</p><p>E-mail Address______Nationality______2015 Hutong Mandarin Learning Summer Camp</p><p>Mailing Address______Occupation______</p><p>Phone Number: Home______Work______Cell______</p><p>Parent/Guardian 2</p><p>Emergency phone number while camper is at camp (If different than above).</p><p>______</p><p>Cabin mates: we’ll try to put friends in the same cabin group, but cannot guarantee it. Please list requested cabin mates below.</p><p>Name______Phone Number______</p><p>E-mail Address______</p><p>Camper’s Medical Information 1. Are you currently receiving any medical treatment?</p><p>Yes </p><p>No</p><p>If yes, what kind of treatment, do you have now?</p><p>______</p><p>2. Does your child have any known allergies (such as dust, drugs, plants, food, etc)? Yes</p><p>No</p><p>If yes, please be specific, what are they?</p><p>______</p><p>3. Do you have any type of special diet that we should know about for medical</p><p> religious reasons? 2015 Hutong Mandarin Learning Summer Camp</p><p>______</p><p>4. Do you have any plan to buy insurance before you arrive at camp?</p><p>______</p><p>Other Information How do you know about our summer camp?</p><p>Google Search </p><p>Facebook Homepage</p><p>Friends’ recommendation</p><p>Chinese teacher’s recommendation </p><p>Other agency (Name)</p><p>Church (if student have to be attending) </p><p>Please give any information concerning your child which will be helpful in His/her experience in group living (such as play, eating, sleeping habits, special fears, like or dislikes.</p><p>Declaration of Application I hereby certify that all the information on this form is true, complete and correct.</p><p>Signature of Applicant______</p><p>Signature of Parent/Guardian (if camper is under 18) ______</p><p>Date______</p><p>PARENT OR GUARDIAN CONSENT</p><p>1. Have legal custody of the herein named child(ren) applying to Edutrip International 2. Declare that the herein named children is are in good physical and emotional 2015 Hutong Mandarin Learning Summer Camp</p><p> health, and amenable to Edutrip International authority 3. Am responsible for payment of fees and any other expenses incurred by my herein named child(ren) 4. Declare that the herein named children attending Edutrip International Summer Camp is/are covered by their provincial health plan or equivalent medical insurance 5. Declare that I have submitted my child’s up-to-date medical information and signed the Consent to Treatment included on the Camper Health Form 6. Give permission to Edutrip International to use any photograph of the herein named children for promotional material 7. By providing my personal information and signing this form, I understand and agree with Edutrip International Privacy Policy as outlined at www.edutripintl.com</p>