Mencius Chinese Academy - Best Chinese Classes in Phoenix

Mencius Chinese Academy
Chinese Language Class Registration Form (Children)
Wibesite: www.menciusacademy.org
Phone: 480-206-3469 Email: www.menciusacademy.org/contact

Student Information:

Name:___________________________________________________

Date of Birth:_____________ Grade Level:________ School:_________________

Chinese Class: _______________________Class Start Date:__________________
Parent Information:

Mother’s Name: _________________E-Mail:______________________________

Address:________________________________________________________

Home Phone: ________________Cell phone: _________________ Work Phone: ____________

Father’s Name: ___________________: E-Mail:___________________________

Address:________________________________________________________

Home Phone: __________________Cell phone: _________________ Work Phone: ___________

Emergency Contact:

Name: ___________________________________________________

Relationship to Child:_______________________________________________

Address:_________________________________________________________

Home Phone: __________________Cell phone: _________________ Work Phone: ___________

Payment Amount:___________

Please make check payable to: North America Literary (or NAL)
Please mail the check to: 8776 E. Shea Blvd. Suite B3A-538, Scottsdale, AZ 85260-6629