Registration Form

Registration Form
Student First Name
First Name
Last Name
Last Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Gender
Fall Grade
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name

First NameLast Name
Parent / Guardian Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Other Parent/Guardian's Name

First NameLast Name
Other Parent / Guardian Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Other Parent/Guardian Email
example@example.com
Emergency Contact Other Than Parent/Guardian

First NameLast Name
Emergency Contact Other Than Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list additional person allowed to pick up your child(ren). Older siblings may pick up provided there is a signed permission letter from the parent and Photo ID of the sibling on file at HuaYi Education. The following individuals may serve as my agent and have my permission to pick up my children from HuaYi Education
Name(Primary person other than parents)

First NameLast Name
Relationship to Student
Driver’s License # (attach a copy of the driver’s license )
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
After School Program
Chinese 标准中文 Free ( $30 book )
Chinese Class Date
Critical Thinking $5/lesson
PACE/GT Prep $400
Summer Camp
Chinese 暨南中文 Free ( $15 book )
PACE/GT Prep $400

Put “ALL” in each column if attending all 5 days; otherwise, write the days attending, i.e. “M,W,F” for 3 days.

Rows	5/27-5/30	6/02-6/06	6/09-6/13	6/16-6/20	6/23-6/27	6/30-7/03
Attending days
Tution (office only)

Please select the optional camp to attend

Rows	5/27-5/30	6/02-6/08	6/09-6/13	6/16-6/20	6/23-6/27	6/30-7/03
Optional Camp

Put “ALL” in each column if attending all 5 days; otherwise, write the days attending, i.e. “M,W,F” for 3 days.

Rows	7/07-7/11	7/14-7/18	7/21-7/25	7/28-8/01	8/04-8/08	8/11 P&A 8/12 FISD
Attending days
Tution (office only)

Please select the optional camp to attend

Rows	7/07-7/11	7/14-7/18	7/21-7/25	7/28-8/01	8/04-8/08	8/11 P&AISD 8/12 FISD
Optional Camp

If you have any special needs, please contact Ms.Sun at the front desk for more informaton.
Check All Items That Apply Below:
1. Transportation - I hereby give do not give* - my consent for my child to be transported by HuaYi Education:
from my child’s public school on field trips and to parks
2. Water activities - I hereby give do not give* - my consent for my child to participate in swimming at the Plano recreation centers (summer program only)
3. Publications, Video, Internet Consent, and Release – I hereby
agree do not agree* - to allow my child to be photographed and videotaped at HuaYi Education and HuaYi Education’s special events (e.g., holiday parties, speech classes and contests, and summer field trips) for the purpose of celebration, evaluations, and promotion of the programs. I may request a hard/soft copy available of my child’s photographs at no charge or make my own copy of videotape at my own efforts.
4. Field Trip - I hereby give do not give* - my consent for my child to participate HuaYi Education field trip events and to travel to and from the events.
Printed Name of Parent/Guardian
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Immunization for After School Students

Please sign both the immunization and emergency health & medical contacts sections.
My child attends the following schools:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Printed Name of Parent/Guardian
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Health and Medical Contacts
Please fill in all blanks including the doctor’s address for safety. Write N/A if not applicable.
Doctor
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
IMPORTANT HEALTH INFORMATION: Please list health conditions, allergies (drug, food, etc.), hospitalization in the past 12 months, medications prescribed for continuous, long-term use, and medical history:
Authorization for Emergency Medical Care

I permit my child * For full participation including gymnastics, basketball, Ping Pong, and all other classes if registered, subject to limitations noted herein. In case of emergency, I understand every effort will be made to contact me, my spouse or next of kin). In the event I cannot be reached to decide on emergency medical care for illness or accident, I hereby give my permission to the licensed healthcare practitioner selected by HuaYi Education to secure treatment, including hospitalization, anesthesia, surgery, or injections of medicine for my child. I further understand I will be responsible for paying for the emergency treatment expenses.
Printed Name of Parent/Guardian
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Signature
HuaYi Education Tuition & Enrollment Policy

1. Registration Fee

For current students:
- A non-refundable Afterschool annual registration fee of $175 is required. Register by 3/14 to waive the registration fee.
- Summer program registration fee: $175. Register by 3/14 to waive the fee, or by 3/31 for a $50 fee.
For new students:
- A non-refundable annual registration fee of $175 is required.
- Summer program registration fee: $175 is required. Register by 3/31 for a $50 fee.
2. Summer Camp Enrollment Requirement
- New students must enroll in a minimum of six (6) full weeks of summer camp to secure a spot in the after-school program.
- Tuition is refundable as Credit. Credit may be issued only for weeks beyond the sixth week and must be used within one (1) year of the issue date.
- If a student attends fewer than five (5) days per week, a daily rate will apply.
3. Late Pick-Up Policy
- HuaYi Education closes at 6:30 PM. Parents must pick up their child(ren) on or before this time.
- After 6:30 PM, HuaYi Education assumes no responsibility for students, including but not limited to accidents or injuries.
4. Electronic Device Policy
- Use of electronic devices (e.g., smartphones, tablets, smartwatches) is prohibited during school hours.
After-School Tuition & Fees

5. Tuition Rates (per payment cycle) (All tuition includes transportation, snacks, and supplies.)
- PISD students: $460
- AISD & FISD students: $480
- AISD Vaughan & Preston students: $500
6. Family Discounts
- $10 off for the second child
- $20 off for the third child
7. Tuition Structure & Payment Schedule
- Tuition is calculated annually: $4,600 per school year for PISD students (school days only).
- The total is divided into ten (10) equal payments, each covering four (4) weeks.
- No refunds or credits for school holidays. Additional charges apply for full-day care on school holidays.
8. No Refunds or Credits for:
- Vacations, illnesses, or school closures due to inclement weather.
- Missed optional classes (contact the instructor for possible make-up sessions).
9. Operating Hours
- School days: 2:45 PM – 6:30 PM
- School holidays: 8:00 AM – 6:30 PM
10. Payment Terms
- Tuition is due by the 5th day of each payment period. A $20 late fee will apply for overdue payments.
- Returned check fee: $30
11. Full-Day Care on PISD School Holidays
- $60 per day for current HuaYi students
- $65 per day for non-HuaYi students
12. Inclement Weather Closures
- HuaYi Education follows ISD closure policies for bad weather days.
13. Observed Holidays (School Closed)
- New Year’s Day
- Memorial Day
- Independence Day
- Labor Day
- Thanksgiving Day
- Christmas Day
14. Withdrawal Policy
- A one-month notice (or one full payment cycle) is required for withdrawals.
- If no notice is given, one full tuition payment will be charged.
Acknowledgment & Agreement
Printed Name of Parent/Guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Registration Form

Authorization for Emergency Medical Care