“I Can Read” Chinese School
Johns Creek: 10450 Medlock Bridge Rd. Suite 111, Johns
Creek, GA 30097
Dunwoody: 4675
North Shallowford Rd. Suite 201, Atlanta, GA 30338
Tel: 678-887-2279;
404-437-2233; Office/Fax: 678-473-6135
Website: www.langcbs.com Email: terry@aeiuo.com
Application Form
School
Year Registration Fee: $ 20 (non-refundable)
Choose
campus ’ Johns
Creek Campus
’ Dunwoody
Campus
Choose program(s): ’
Chinese ’ Academic
Enhancement ’ SAT
Prep.
Chinese name __________________ English name
____________________
Age：__________ DOB: ______________ Current Grade：______________ Regular School Name：____________________ County:_________________ Dominant Language spoken at home: ____________ Home Address __________________________________________________ Home phone: ____________________
Work phone:
___________________ Mother’s Name_______________ Mother’s Cell phone
#:___________________ Father’s Name_______________ Father’s Cell phone
#:___________________ Mom’s Email： ___________________ Dad’s E-mail ________________________ Emergency Contact person : _____________________ Phone # ___________________ Allergies or other health concerns: _________________________________ Insurance Company：______________________________________________ Parent/legal Guardian Signature___________________________ Date of Application：__________________ |