"Become a Gong Fu Panda – 2017 Chinese Language and Culture Summer Camp" Registration Form

(Note: *denotes required fields. This form is to be SUBMITTED ELECTRONICALLY, not mailed)

Camper’s Information

First Name:*

Last Name:*

Gender: *

Male
Female

Birthday: *
In this format: DD/MM/YYYY

Which group would you like to register for?*

Class A (age range 6-8)
Class B (age range 9-11)
Class C (age range 12 & older)

How many weeks are you going to attend?*

1
2
3

Check the week or weeks you are attending*

Week 1 (6/12 – 6/16)
Week 2 (6/19 – 6/23)
Week 3 (6/26 – 6/30)

What is the camper’s T-shirt size*

Select one:

Mailing Address:*

Street:

City:

State:

Zip:

Parent’s or Guardian’s Information

Parent’s or Guardian’s Name: *

Parent’s or Guardian’s Email: *

Parent's or Guardian's cell phone #:*

Emergency Contact #: *

How did you hear about us?*

Select one:

Please hit the Submit button below. Note: This form is to be SUBMITTED ELECTRONICALLY, not mailed.