PERSANAL DETAILS

Father's name (Chinese)  _____________ (English)___________

Mother's name (Chinese)  ____________ (English)___________

Students

Name (English) (Chinese) Date of Birth Sex Grade School

____________ _____________ ________  _______ ____ _____________________

____________ _____________ ________  _______ ____ _____________________

Student's passport/China entry permit details  _______________________________

Address _________________________________________postal code ___________

Home telephone ______________ Office telephone ____________Mobile_________ Fax ____________ Email _______________________________________________

The selected course: Putonghua Speaking □

                 Putonghua Writing  □

                 Parent Camp       □

Extra interest & excursions:

Chinese Calligraphy □  Chinese Brush Painting □  Tai Chi □  Singing □

Chinese Dance    □   Musical Instruments, Piano □  Guitar □ Violin □

Saxophone  □  Erhu □ Pipa □  Guzhen □ Sports  □   Sightseeing □ 

Please state others _____________________________________________________

Does your children have any health problem? No, _______ Yes, ________  If yes,

Please explain: (include any medication taken on a regular basis and allergies)

____________________________________________________________________

EMARGENCY MEDICAL TREATMENT AUTHORISATION

   If a parent or guardian can't be contacted, I / we hereby authorize Oriental Pearl College and / or its representative to take my child to my / your authorized hospital if and when emergency care is needed and do not hold the school and/or its representative responsible for authorizing treatment or for any costs/expenses resulting from such treatment. I / we also authorize Oriental Pearl College to perform any emergency care deemed necessary for the treatment of my child.

Signature of the student ________________________ Date ___________________

Signature of the parent or guardian _______________Date ____________________