Skybridge    

http://www.skybridgechinese.com/

Summer Camp Application Form

2016 Skybridge Chinese Learning Summer Camp

Application Form

Child’s English Name: _______________   Chinese Name:_________________  

DOB:_____________ Sex:________ Mandarin Level: No A little Basic Good

School attended:none Daycare Preschool K Grade___ Chinese Link:Yes No

School Name (if any):_____________________________________________________

Parent’s/ Guardian’s Name: _________________________________________________

Cell Phone: __________Home Phone: ___________Email: _________________________

Address: ______________________________________________________________

*Other Emergency Contact Person: _____________________ Phone: ________________

Food Allergy/ Restriction: __________________________________________________   

★★ Please indicate the sessions you would like your child to attend ★★★

8:30am-4:00pm $268/week, no registration fee, after care 4:00pm-6:00pm $10 per hour

Session 3 $198/4days

Session          Date         Tuition + Extra Care [email protected]         =     Total  

Session 1   06/20-06/24       $___+ ($10x ___ hr. ___ to___) $____ =     $_____ 

Session 2   06/27-07/01       $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 3   07/05-07/08 4days $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 4   07/11-07/15        $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 5   07/18-07/22       $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 6   07/25-07/29       $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 7   08/01-08/05       $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 8   08/08-08/12       $___+ ($10x ___ hr. ___ to___) $____ =     $_____

Session 9   08/15-08/19        $___+ ($10x ___ hr. ___ to___) $____ =     $_____

                                                           Subtotal =    $_____

  Please make checks payable to Skybridge International Inc. and mail the form to the camp location:  1140 SW 11th Ave. Suite 110, Portland,OR,97205

*Application deadline is May, 31 . After that, application can only be accepted when space is still available. First Come, First Serve. Only paid applications are guaranteed for enrollment. Once registered, any withdraw request will be charged with a $30 administration fee. No refund will be given after the sessions starts. In case of insufficient enrollment, the camp will be cancelled and full refund will be given.

Lunch prepared by student’s own self. Summer camp cost does not include admission tickets if needed during the field trips .

Signature of Parent/Guardian: ________________ Date: ________

 

** For office use only:

Payment of $________ (Check # ________ ) received on _______ by______