Young Eagle After School Classes Registration Form
August 25 -- December 17

After School Mandarin Language Classes for Elementary School Age Children

Classes Offered from 1 to 5 Days a Week (3:30 – 5:30)

To reserve a place for your child, please complete this form and mail to 625 East NC Hwy 54, Durham, NC 27713 with your $30 registration fee. Checks should be made out to DCS. See below for tuition payment schedules.

Please note that once registered you are obligated for full semester tuition. The only exception is for families who move more than 50 miles away from DCS. Those families must turn in a written notice 30 days in advance to receive a prorated tuition refund or waiver.

Discounts: If your child is also registered in our Little Panda Preschool program then you receive a 50% discount and waiver of the $30 registration fee. (NOTE: These children are in separate age classes from the elementary school age students). Also, if the child registered is a sibling of a child in the preschool program you receive a 10% discount but the $30 fee applies.

Make Up Classes: If your child misses a class they may make that class up during the same week.

 Payment 1 Day
 2 Day
 3 Day
 4 Day
 5 Day
 1st Due 8/1
 $248 $248 $248
 $331
 $414
 2nd Due 10/1
 $0 $248 $248
 $331 $414
 3rd Due 11/15
 $0 $0 $248 $330 $413
 Total Payment
 $248 $496 $744
 $992 $1240

Please write your child’s name and circle the days of the week you are signing them up.

Student Name: ______________________ Mon Tues Wed Th Fri

*** Please check here ____if your information has changed***

Birthday: _________________________ Age: _____ Sex: _____

Allergies: _____________________________________________


_____________________________________________________

Home Address:

Street: _______________________________________________

City, State, Zip: ________________________________________

Parent Name: __________________ Cell Ph: (_____)__________

Work Ph: (_____)____________ Email: ____________________

Parent Name: __________________ Cell Ph: (_____)__________

Work Ph: (_____)____________ Email: ____________________

Emergency Contact Name & Phone:
_____________________________________________________

Persons Authorized to Pick Up Your Child From School
_____________________________________________________

_____________________________________________________

Guardian Signature: ______________________ Date: _________
For more information please contact Principal Xiaoping Johnson at 919-308-3511, xpj@earthlink.net or visit our website at www.littlepandapreschool.org.