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Let’s Learn Chinese! 来学中文!
@ P.K. Yonge DRS, August 3-7 and August 10-13
A complete registration form and full payment is required to register for this camp. Make checks payable
to: University of Florida. Applications will be accepted on a first come, first served basis, as there may be a
waiting list.
Camper’s Full Name
Entering Grade
Age
School Attended
Gender
_
Parent/Guardian Name
Parent/Guardian Address
PKY is committed to ensuring that all the teaching and learning takes place in a safe, secure, and
orderly environment. ALL CAMPERS must understand and follow the PKY Student Code of Conduct
in this summer camp. Here is the link to PKY’s Student Code of Conduct: http://goo.gl/hJhmol . Please
read and make sure the applicant understand the expectations before you apply.
Contact Information
Parent/Guardian Email Address
Parent Home Phone _
_
Parent Cell Phone
Parent Work Phone
Emergency Contact Information
EMERGENCY Contact Name
Relationship: __________
Contact Home _________Phone Cellphone___________
Work phone
ALTERNATE EMERGENCY Contact E-mail
_
ALTERNATE EMERGENCY Contact Physical Address
City
Physician
Insurance Provider
State
_
Zip
Physician Phone
Policy #
Medical information we should be aware of:
Names of people who are authorized to pick up your child (include authorized parents):
1.___________________________________ 2.________________________________
3.___________________________________ 4.________________________________
DROP-OFF AND PICK-UP POLICY
Drop Off
Let’s Learn Chinese will be held at P.K. Yonge Developmental Research School (PKY). No unsupervised
children are allowed on school property. Beginning at 8:45 each morning, 15 minutes prior to the beginning
of class, instructors will be on duty to meet you and your child on the front circle. Do not drop off your child
earlier than 8:45 am.
Pick Up
Your child must be picked up by 12:15pm, which is 15 minutes after the class ends. Your child will only be
released to individuals you have authorized on the application form and photo identification will be required
for pick-up. Childcare and camp activities are being offered after Let’s Learn Chinese by Blue Wave After
School, Inc. (call 352-692-3007 for more information).
I understand the drop-off and pick-up policies.
Parent or Guardian Signature ________________________________Date_________________
VIDEO/IMAGE RELEASE
I hereby give my consent to the Let’s Learn Chinese Summer Program to photograph or videotape my child
and use these photos or videotapes for training future tutors and for other marketing or archival purposes.
Parent or Guardian Signature_________________________________ Date_________________
Make checks payable to University of Florida
Registration Fee:
$100 (Two Weeks)
Refund policy: NO REFUNDS
I give permission for my child to participate in all camp activities. In case of sickness or injury, I give
permission to an instructor to seek treatment for my child from the physician named above if a
parent/guardian or contact person cannot be reached. I also understand that Learn Chinese does not provide
insurance coverage for medical treatment. I have read and understand the medical policy, which is stated
above. I also understand that there are no refunds.
Parent/Guardian signature
http://summer2015.pkyonge.ufl.edu