7/28/2019 Registration Form A2 - Elementary Korean Language

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REGISTRATION FORM A2 ELEMENTARY KOREAN LANGUAGE

YEAR: TERM: DATE OF REGISTRATION: REG#:

PHOTO

(passport size)

FULL NAME (last, first, middle): NICKNAME: AGE: CIVIL STATUS:

SINGLE MARRIEDBIRTHDATE:

LANDLINE: MOBILE NUMBER:

PRESENT ADDRESS:

PERMANENT ADDRESS:

NATIONALITY: LAST SCHOOL ATTENDED/GRADUATED:

INSTITUTION/COMPANY:

EMPLOYER (if any): I.D.s PRESENTED: START DATE:

E-MAIL ADDRESS: FACEBOOK USERNAME/E-MAIL: END DATE:

HOW DID YOU FIND OUT ABOUT KCC?

Internet Friends School/Work

Newspaper Magazines Others (Please specify): ________________________

PURPOSE FOR STUDYING KOREAN:

Business/Employment Academic Hobby/Interest Others (Please specify): ________________________

CHOOSE YOUR CLASS SCHEDULE

SECTION TEACHER DAYS MIN. AGECLASS

MATERIALS FEE

PUT A

CHECK

ELEMENTARY 1 - A JUNG Myung-jin MON & WED 9am-12nn

16 P 1,500.00

ELEMENTARY 1 - B KANG Hyo-kyung TUE & THU 9am-12nn

ELEMENTARY 1 - C NOH Ok-jin TUE & THU 2pm-5pm

ELEMENTARY 1 - D YOON Ha-kyung MON, TUE, THU 6pm-8pm

ELEMENTARY 2 NOH Ok-jin MON, TUE, THU 6pm-8pm

HISTORY OF KOREAN LANGUAGE (leave blank if not applicable; write year and term for old KCC students)

DATES ATTENDED NAME OF INSTITUTION & INSTRUCTOR TEXTBOOKS USEDTOTAL # OF

HOURS

In case of self-study, please provide details as to how much you know of Korean Language.

2013 2ND

7/28/2019 Registration Form A2 - Elementary Korean Language

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ACCIDENT WAIVER AND RELEASE OF LIABILITY

This form must be read carefully, completely filled out and signed by the student

(or the students guardian enrolled) in the Center (no faxed or photocopied signatures).

Emergency Contact Person/s: (Please list down at least two people.)

Names Relation CP/land line

1.

2.

Allergy/other necessary information: Students BLOOD TYPE:

In consideration of my voluntary application and participate in the class programs of the Center, I acknowledge that I

am under the tutelage of the Korean Cultural Center in the Philippines.

I acknowledge that the class may involve a test of a persons physical and mental limits and may carry with it potential

risks. I accept full responsibility for my physical condition and hereby certify that there are no health-related reasons

or problems that preclude my class participation. I

I hereby attest that I will not put my health at risk especially at times when I have doubts about my capabilities in

completing or performing the activities in class.

I agree to solely bear all costs of such injury or damage to myself as well as the property damages that I may cause

during my stay in the Center.

I further agree to abide by all the rules and regulations as set forth by the Korean Cultural Center whether written or

verbal.

I hereby certify that I have read this document and understand its content (no faxed or photocopied signatures).

Students signature: __________________________ Date:_____________

PRINTED NAME

PARENT/GUARDIAN WAIVER FOR MINORS ONLY

(Under 18 years old)

The undersigned parent and legal guardian does hereby represent that he/she is, in fact, acting in such capacity, has

consented to his/her child or wards participation in all activities or events, and has agreed individually and on behalf

of the child or ward to the terms of the accident waiver, release of liability as stated above.

I certify that I have read this document, and I fully understand its content.

Guardians signature: __________________________ Date:_____________

PRINTED NAME