WSCC Summer Dance Program 2017 Enrollment Form

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I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. _____ No,
WINCHESTER SCHOOL OF CHINESE CULTURE

WSCC Summer Dance Program 2017 Enrollment Form Student Information： ： Student1 Name (学生姓名):_____________________________ Age (年龄)：________

Gender (性别): M

F

Gender (性别): M

F

Student2 Name (学生姓名):_____________________________ Age (年龄)：________

Parent Information： ： Parent Name (家长姓名):_________________________ Phone (电话): __________________ Email (电邮):_______________________________________

Address (地址):______________________________________________________________

City:

_______________

State:

Emergency Contact Name:

_______

Zip Code:

_______

_________________________

Phone:

_____________

Registration Program Session (dates) Aug 21 – Aug 25 Aug 28 – Sep 1 (2 weeks) Notes: Open hours: 8:30am-5:30pm Bring own lunch Program Location: Winchester Unitarian Church 478 Main Street Winchester, MA 01890

Please make check payable to: WSCC

Tuition

First Child

Second Child

$350/week Discount : Early Bird(