报名表 Registration Form

*请复制本报名表并填写个人信息后发送email至gcccworldwide@yahoo.com

学生信息/Student Information

学生姓名/Student's name_________________
学生2012年秋季升入年级/Grade in Fall 2012________________
就学学校/Name of School____________________
生日/Date of birth______________________
性别/Gender : 男/Male_________女/ Female___________
家庭住址/Address _________________________________________________
_________________________________________________
邮编/Zip code_________________

英文水平/Level of English language :

只懂很少的英语/Very little English____________________
会一些英文，但不很熟练/ Some English _________________
掌握很熟练的英文/ Fluent in English_______________
是否去过美国/Been to the U.S.A before? 是/Yes_______否/No______
是否去过其他国家/been to other countries before? 是/Yes_________否/No____________
请列举/please list the countries you've been_______________________________

家长信息/Parent Information:

家长姓名/Parents names __________________
单位电话/Parents work phone numbers________________
宅电/Home phone number________________
手机/Cell phone number:_______________
电子信箱/Parent's email address:_____________

我同意我的孩子_________参加夏令营组织的一切活动，并同意组织者将有我的孩子在内的照片放入宣传册中。如果孩子在活动过程中生病或是受伤，我在这里授权给组织者全权处理。
As the parent of above named student I give permission for my child to participate in all of the activities and for the
GCCC to use photographs including my child in promotional materials. In case of illness and injury I authorize the camp to provide and obtain medical care for my child.

家长签名/Parent's signature:_________________

*如有疑问或需要更多信息请联系 Stephanie Tansey 女士 或 范敏坚 先生
邮箱地址：gcccworldwide@yahoo.com
For more information. Please contact Stephanie Tansey or Mac Fan at gcccworldwide@yahoo.com