YEAR: 2013

REGISTRATION FORM A2 ELEMENTARY KOREAN LANGUAGE TERM: 2ND DATE OF REGISTRATION:

FULL NAME (last, first, middle): NICKNAME: AGE: BIRTHDATE:

REG#:
CIVIL STATUS: SINGLE MARRIED

PHOTO (passport size)

LANDLINE: PRESENT ADDRESS: PERMANENT ADDRESS:

MOBILE NUMBER:

NATIONALITY: EMPLOYER (if any): E-MAIL ADDRESS:

LAST SCHOOL ATTENDED/GRADUATED: INSTITUTION/COMPANY: I.D.s PRESENTED: FACEBOOK USERNAME/E-MAIL:

START DATE: END DATE:

HOW DID YOU FIND OUT ABOUT KCC? Internet Newspaper Friends Magazines School/Work Others (Please specify): ________________________ PURPOSE FOR STUDYING KOREAN: Business/Employment Academic Hobby/Interest Others (Please specify): ________________________

CHOOSE YOUR CLASS SCHEDULE

SECTION ELEMENTARY 1 - A ELEMENTARY 1 - B ELEMENTARY 1 - C ELEMENTARY 1 - D ELEMENTARY 2 TEACHER JUNG Myung-jin KANG Hyo-kyung NOH Ok-jin YOON Ha-kyung NOH Ok-jin DAYS MON & WED 9am-12nn TUE & THU 9am-12nn TUE & THU 2pm-5pm MON, TUE, THU 6pm-8pm MON, TUE, THU 6pm-8pm MIN. AGE

CLASS MATERIALS FEE

PUT A CHECK

16

P 1,500.00

HISTORY OF KOREAN LANGUAGE (leave blank if not applicable; write year and term for old KCC students)
DATES ATTENDED NAME OF INSTITUTION & INSTRUCTOR TEXTBOOKS USED

TOTAL # OF HOURS

In case of self-study, please provide details as to how much you know of Korean Language.

ACCIDENT WAIVER AND RELEASE OF LIABILITY

This form must be read carefully, completely filled out and signed by the student (or the students guardian enrolled) in the Center (no faxed or photocopied signatures). Emergency Contact Person/s: (Please list down at least two people.) Names Relation 1. 2. Allergy/other necessary information: Students BLOOD TYPE:

CP/land line

In consideration of my voluntary application and participate in the class programs of the Center, I acknowledge that I am under the tutelage of the Korean Cultural Center in the Philippines. I acknowledge that the class may involve a test of a persons physical and mental limits and may carry with it potential risks. I accept full responsibility for my physical condition and hereby certify that there are no health-related reasons or problems that preclude my class participation. I I hereby attest that I will not put my health at risk especially at times when I have doubts about my capabilities in completing or performing the activities in class. I agree to solely bear all costs of such injury or damage to myself as well as the property damages that I may cause during my stay in the Center. I further agree to abide by all the rules and regulations as set forth by the Korean Cultural Center whether written or verbal. I hereby certify that I have read this document and understand its content (no faxed or photocopied signatures). Students signature: __________________________ Date:_____________ PRINTED NAME PARENT/GUARDIAN WAIVER FOR MINORS ONLY (Under 18 years old) The undersigned parent and legal guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or wards participation in all activities or events, and has agreed individually and on behalf of the child or ward to the terms of the accident waiver, release of liability as stated above. I certify that I have read this document, and I fully understand its content. Guardians signature: __________________________ Date:_____________ PRINTED NAME