Online Registration Form

Firstname: *

Lastname: *

Gender: *

Email Address: *

Phone (day time): *

Phone (night time):

Street Address: *

City: *

State: *

zip code: *

Please select your class: *

Payment Method: *

Today's Date: *

For Parens/Guardian Only

Child Lastname:

Child Firstname:

Child Age:

Child Gender:

Relationship to child:

I give my permission and consent for the child named above to participate in the Chinese Culture and Mandarin Class. While expecting the Global Competency Consulting LLC ("GCC") staff to look after the safety of the before mentioned child, I hereby release them and GCC from liability for any injury or illness they may sustain during the class hours.
In the event of an emergency, where medical treatment is required, I hereby give my permission and consent to Global Compentency Consulting Staff, Instructors, and Volunteers to obtain the services of a paramedic (i.e. ambulance). I understand the GCC staff will try and notify me immediately of any such emergency.
Photos and videos are periodically taken of people participating in GCC's programs and activities. All persons registering for programs, trips, or activities thereby agrees any photograph or video image taken by GCC's program may be used for educational and promotional purposes including its electronic media, videotapes, brochures, flyers and other publications without additional, prior notice or permission and without compensation to the participant.

Parent/Guardian Signature (Please type your full Name below):

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