000 한국학교

000Korean School

www.00koreanschool.org

Logo                                                          00koreanschool@gmail.com

입학원서( APPLICATION FORM )

SECTION 1: Class Registration

학생 Student	이름(Name)		New Student	성별 Gender	생년월일 Date of Birth (mm/dd/yy)	출생지 Birth Place	나이 Age	학년 Grade	배정반
	Korean	English
1st			□	M / F	/ /	Korea/USA
2nd			□	M / F	/ /	Korea/USA
3rd			□	M / F	/ /	Korea/USA
4th			□	M / F	/ /	Korea/USA

** Korean Language and culture Class: Fri. 6:50-8:55(pre K, K) / 9:10 PM

** Enrichment class starts at 5:50-6:40 PM

과목/ Class	시간/ Time		등록금/ Tuitionv		소계/Sub Total
한국어/Korean (PK~Adult)	6:50 - 8:55 / 9:10		1stChild$210 2nd3rd$160 4th$110 parents $100
미술/Art (1st~12th)	5:50 - 6:40		With Korean $120 x ( ) / Art only $170 x ( )
종이접기/ Jong-ie Jopgi (1st~12th)	5:50 - 6:40		With Korean $120 x ( ) / Jong-ie Jopgi only $170 x ( )
종이랑 미술이랑/Art (PK&K)	5:50 - 6:40		With Korean $120 x ( ) / Art(Pre – K) only $170 x ( )
음악교실/Kids Music (PK&K)	5:50 - 6:40		With Korean $120 x ( ) / Kids Music only $170 x ( )
장구/Korean Drum (5st~12th)	5:50 - 6:40		With Korean $100 x ( ) / Korean Drum only $150 x ( )
운동/Sport Sampler (K ~ 2nd)	5:50 - 6:40		With Korean $100 x ( ) / Sport Sampler only $150 x ( )
농구/Basketball (3rd~9th)	5:50 - 6:40		With Korean $100 x ( ) / Basketball only $150 x ( )
한국무용/Korean Dance (3rd~6th)	5:50 - 6:40		With Korean $100 x ( ) / Korean Dance only $150 x ( )
한국어 회화반/Korean Conversation (1st~12th)	5:50 - 6:40		With Korean $50 x ( ) / Korean Conversation only $100 x ( )
** Please make your check payable to 000(000 Korean School) There will be a $20 charge for each returned check		교재비/ Pre K, K Text Book		$ 15 x ( )
		PTA Fee (each family)		Each $15 Only for Korean classes ( )
		합계/ Total		$
		Check #

SECTION 2: 연락처/CONTACT INFORMATION

Parent/Guardian:	Relationship to Student

Best Contact Phone

Email

Address

If you available in an emergency, norify :

Name:	Relationship:

Phone:

♣♣ 이번 페이지는 학교의 안전 관리를 위한 부모님 동의사항 입니다. 각 학생마다 한 장씩 제출하여 주시기 바랍니다.

This page includes all official documents. Parents and / or guardians must sign on behalf of their child. Each individual child must have each form filled out for them.

학생이름/Student’s Name: 한글(Korean):	English:

전화/ Phone:	Class:

SECTION 3: 응급 의료사항 위임/MEDICAL AUTHORIZATIONS (MUST BE COMPLETED TO PARTICIPATE)

긴급한 의료 상황에서 본인과 연락이 불가능할 시에 제 자녀의 안전을 위한 모든 권한을 학교에 위임하고 필요로 하는 의사의 적절한 시술을 허락합니다.

Parent/Guardian Authorization: This participant’s health history is correct and complete as I know and the person here in described has permission to engage in all activities except as noted. In the event I cannot be reached in an emergency, I hereby give permission to the physician select by the school to secure and administer treatment, including hospitalization, for the student.

부모/보호자이름, 서명(Parent/Guardian’s Printed Name, Signature)     날짜(Date)

SECTION 4: 학생의 특이 체질이나 병력/SPECIAL MEDICAL AUTHORIZATIONS (MUST BE COMPLETED TO PARTICIPATE)

긴급한 의료 상황에서 본인과 연락이 불가능할 시에 제 자녀의 안전을 위한 모든 권한을 학교에 위임하고 필요로 하는 의사의 적절한 시술을 허락합니다.

SECTION 5: 부모님 책임/PARENT RESPONSIBILITIES

본인은 이 학생의 부모/보호자로서000한국학교에 등록을 원하며, 의무를 성실히 이행할 것을 서약합니다.

I would like to register my child at 000 Korean School and promise to positively support the school’s academic and extracurricular activities.

*Would you like to sign up for volunteering opportunities?     □Yes        □No

부모/보호자이름, 서명(Parent/Guardian’s Printed Name, Signature)     날짜(Date)

SECTION 6: 법적 책임 해제 확인/LIABILITES RELEASE CONFIRMATION

본교의 교사들은 자녀의 안전을 위하여 최선을 다할 것입니다. 그러나 학사일정 중에 일어난 어떠한 사고에 대해서도 학교당국은 책임질 수 없습니다. 본인은 부모/보호자로서 학교당국의 법적 책임에 대한 조건에 동의하며 이에 입학원서를 제출합니다.

The staff of this school will do their best to assure all possible safety measures for your children while in school.

However, the school will not assume any liability incurring during the school period, I read condition and I waive my rights to take any legal action against this school and/or its staff.

부모/보호자이름, 서명(Parent/Guardian’s Printed Name, Signature)     날짜(Date)

SECTION 7: PHOTO/VIDEO

본인은 자녀의 사진 및 비디오 촬영과 공공의 목적을 위한 사용을 허락합니다.

I give permission for my child to be photographed / filmed, and permit the school to publicly release this footage.

부모/보호자이름, 서명(Parent/Guardian’s Printed Name, Signature)     날짜(Date)