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New World Bilingual Institute 新 世 界 雙 語 學 院 Registration Form 報名表

www.nwbi.us; nwbius@yahoo.com703-978- 7905 

Registration Fee: $ 10 (Nonrefundable) + Set Class Fees

学生中 英 文 姓 名 Student Name (Chinese & English)

性 別Gender

个人资讯

Personal Info.

國籍 Nationality

生日Birth Date

mm/dd/yy

出生地Birth Place

Student’s E-mail:

Enroll Semester:

地址Home Address :

电话Home Phone

父母联系资讯(中英文)Parent’s Name and Basic Info.

Father ________________ 职业Occupation __________

E-mail:ReachablePhone:

Mother 职业Occupation __________

E-mail:ReachablePhone:

NWBI 注册科目:

学生就讀美国學校/年級

Student’s US School

Grade

主修College Major

特殊需要Special Need:

过敏 Allergy:

医药Medicine:

在家使用何種語言

Language Spoken at Home

Student’s ReachablePhone:

Signature:________________

Date:______________

Parents /Guardian’s 监护人

Phone:

Signature:______________

Date:

警急联系人

EMERGENCY CONTACT:

Name_________________

Phone________________

Email:

同意書LIABILITY WAIVER: Neither New World Bilingual Institute(NWBI), or George Mason University shall be held liable or responsible for any expenses, loss, injury, damage or death of whatsoever nature arising from the use of any conveyance, accommodations, or services, or Unpredicted cause of weather, fire, war, strikes or terrorism. No responsibility is accepted for any damage or delay due to government regulation and insufficient or any causes beyond control. Should a medical emergency arise during the classes or events, organizers reserve the rights to seek any medical treatment it deems necessary and appropriate at the participant’s own expense. In the event something serious happens beyond control, the participant and/or parents and/or guardian will not hold NWBI , GMU responsible and other co-sponsor organizers and officers responsible. I understand that my child or ward has to be in perfect health (physical/mental), under no medication; the participant has to follow the NWBI code of the conduct rules at all time. Any school probity was damage cause by the participant, he/she would be responsible the repair or replace the costs. NWBI reserves the right to discipline the participant's unacceptable behavior as it occurred. I agree to be responsible for any extra cost that is on behaved of my child, ward or myself. (** Be sure to escort your child/ren to the classroom designated area and leave he/she to a teacher (in present) before parent / guardian take off.)