Great Wall Registration Form

Student's Name:*
Gender:*
Grade *
Name of school and City
Homeroom teacher's Name
Best Contact Phone:*
Mother's Name
Mother's Phone#
Father's Name
Father's Phone#
Parent(s) Contact Email:*
Home Address:
Referrer's Name:
Program Selected
After School
After School (locations)
Date to attend:
Class Selection:
Weekend /Evening Class (Please refer to the "Evening & Weekend schedule" sheet to see the course information)
Course Code:
Course Name (Class):
Date & Time:
Teacher:
Tuition ( only the number) : $
Release & Rules