RSIOC Chinese Enrichment Immersion Registration Form

RSIOC Chinese Immersion Enrichment Program 2025-2026

Registration Form (Ages 4-6)
Chinese Immersion Sessions and Fees
Please check the session(s) in which you would like to enroll:*

Session I (Oct 1 - Dec 18, No class on Nov 27 and 28) - Rate: $2,200/sessionSession II (Jan 6-March 27, No class on Jan 19, Feb 16) - Rate: $2,280/sessionSession III (Apr 14-June 18, No Class on May 25) - Rate: $1,880/session
Program Schedule:

The Cultural Immersion Enrichment program will take place on Mondays, Wednesdays, and Fridays from 3:00 to 4:00 pm (except the dates listed above).

Program Fees:

Program fees are due in full with registration form 14 days before the start of each session.

Program Fees are Non-Refundable.
Student Information
Full Name (English)*

First NameLast Name
Chinese Name (If any)
Date of Birth (DOB)*

MonthDayYear
Date
Age
Gender*
Current School*
Has your child learned Chinese before?*

NoYes
If yes, how long? (In years)
Language Level*

BeginnerIntermediateAdvancedHeritage Speaker
Learning Goals
Additional Information
Parent's cell phone*
Parent's cell phone
Parents email*
example@example.com
Parents email
example@example.com
Emergency Contact Name*
Relation to Student*
Phone Number*
Payment Type*

CheckCharge my School Account
Amount Enclosed
Check Number
Charge my school account amount:
*Make checks payable to Renascence School International, OC (There are no refunds or credits for missed classes)
I, parent/guardian name* , hereby give permission for my child, child's name* to participate in the RSIOC Chinese Enrichment Immersion Program 2025. In consideration of permission granted to the above-named student to attend the Chinese Enrichment Immersion Program, I hereby release and discharge the Future Leaders Academy DBA Renascence School International, Orange County (RSIOC), its franchisor, its agents, employees, officers and board members and others affiliated with the RSIOC from all claims, demands, actions, judgments, execution, and liabilities for all personal injuries, known or unknown, and injuries to property, real or personal, caused by, or arising out of, the RSIOC Chinese Enrichment Immersion Program. I also agree to binding arbitration in the event of a serious conflict, disagreement or dispute brought by me, my family and/or my child against the RSIOC, its employees, its board of directors, its agents, its volunteers, and/or others affiliated with the school.

I further hereby authorize a representative of the RSIOC to consent to medical treatment of the above-named student in the event of an emergency during the Chinese Enrichment Immersion Program.

I, the undersigned, have read this release and understand all its terms including the consent to medical treatment. I execute it voluntarily and with full knowledge of its significance.
Medical concerns/Allergies:
Children who are not currently enrolled with RSIOC will need to provide California State Health Form or a Standard Pediatrics Well-Child Form with the registration form in order to join the class.
Photo/Video Release
I hereby give permission for video, photo, digital and other images of me/us and/or my child, child's name* ,captured during the Chinese Enrichment Immersion Program, to be used by RSIOC, Renascence School Group solely for the purposes of hard copy and electronic promotional materials and publications and waive any rights of compensation or ownership thereto.
Parent 1 Printed Name*
Parent 1 Signature*

Clear
Date*

MonthDayYear
Date
Parent 2 Printed Name
Parent 2 Signature

Clear
Date

MonthDayYear
Date
Food Agreement

Future Leaders Academy
I/We parent's first and last names* being the legal Parent(s)/Guardian(s) of student's name*, a prospective student of the Future Leaders Academy DBA (FLA) for the Since the FLA goal is to teach advanced material, the FLA teachers need learning-ready children. Research suggests food high in sugars, preservatives, artificial sweeteners and/or flavor enhancers can cause behavioral difficulties in children and make learning difficult. Also, research suggests children tend to be happiest and perform the best when they are fed a balanced diet that includes protein, fruit, vegetables and carbohydrates. To help ensure my child is ready to learn:

1. I will provide food and drink for my child's snack(s) and lunch.
2. I will not send food or drink that has more than 6 grams of added sugars per package label serving (including cookies, candy, soft drinks, fruit juice, etc Added sugars include cane sugar, beet sugar, corn syrup, high fructose corn syrup, fructose, molasses, honey, maple syrup, cane juice, etc.
3. I will not send food with artificial preservatives, artificial sweeteners, artificial colors, artificial flavorings, flavor enhancers and food additives for snacks or lunch. Artificial preservatives, flavorings and flavor enhancers include, but are not limited to, BHA, BHT, TBHQ, Splenda, Aspartame (NutraSweet), Saccharine, and MSG (monosodium glutamate
4. I/we will only send unopened packages that include nutritional information on the outside of the packaging (or a copy of the label), if an item COULD have preservatives or more than 6 grams of added sugar. This step keeps FLA teachers from spending an inordinate amount of time trying to figure out if something meets the policy. Items in this category include applesauce, cakes (including banana, zucchini and other sweetened breads), cookies (of any type, small or large), granola/cereal bars, Cheetos, Doritos, other flavored chips, yogurt, and fruit juice.
5. I will not allow my child to bring gum to school.

I/We understand that admittance of my/our child to the FLA for the 2025 Chinese Enrichment Immersion Program, enrollment of my/our child in the FLA for 2025 Chinese Enrichment Immersion Program and attendance of my/our child at the FLA during the 2025 Chinese Enrichment Immersion Program is contingent upon my/us signing this Food Agreement.
Parent 1 Printed Name*
Parent 1 Signature*

Clear
Date*

MonthDayYear
Date
Parent 2 Printed Name
Parent 2 Signature

Clear
Date

MonthDayYear
Date
Authorization to Release 2025-2026

Future Leaders Academy
Student's Name (one form per child)*

First NameLast Name
Date Completed*

MonthDayYear
Date
I authorized the following people to pick-up my child, child's name , from the Renascence School International, Orange County Campus.
1. Full Name*
1. Driver's License Number:*
2. Full Name
2. Drivers License Number
3. Full Name
3. Drivers License Number
4. Full Name
4. Drivers License Number
4. Full Name
5. Drivers License Number
5. Full Name
6. Drivers License Number
6. Full Name
7. Drivers License Number
7. Full Name
8. Drivers License Number
9. Full Name
9. Drivers License Number
10. Full Name
10. Drivers License Number
I understand once I add a name to this list, my child will be released to the person on the list without notifying
Parent 1 Printed Name*
Parent 1 Signature*

Clear
Date*

MonthDayYear
Date
Parent 2 Printed Name
Parent 2 Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

RSIOC Chinese Immersion Enrichment Program 2025-2026

Chinese Immersion Sessions and Fees

Program Schedule:

Program Fees:

Student Information

Additional Information

Photo/Video Release

Food Agreement

Authorization to Release 2025-2026