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AMERICAN CHINESE ART SOCIETY
CHINESE DANCE SUMMER WORKSHOP

APPLICATION FORM

Student's Name:                                                                    English   _____________________________________________________________


(please print)                                                                        Chinese _____________________________________________________________

Birth Date: (Mo/Day/Yr)
(must be age 6 & above)

     ______/____/_______

Sex:

 M   ___                   F   ___

Height:

 

Weight:

 

Address:

______________________________________________

______________________________________________

______________________________________________

Parents' Name:
(please print)

English: Father _________________________________

English: Mother ________________________________

Chinese: Father ________________________________

Chinese: Mother _______________________________

Home Phone:

e-mail

  

Work Phone:

 

Student's Dance
Training Information:

Number of years studied:
Ballet __________________________
Modern Dance ___________________
Chinese Dance ___________________
Other Dance _____________________

Student's Signature :

 Date: ____________________________

Parent's Signature:

 Date: ____________________________

Please type or print clearly and filled out each item completely

To register for the Chinese Dance Summer Workshop, please complete the Application Form
& Waiver Liability Release Form and mail with tuition by June 25, 2010 to:

American Chinese Art Society
111 Truman Road, Newton, MA 02459-2640
Tel. (617) 332-5376