网上注册 - AFTER SCHOOL

* 请完整填写以下信息进行注册。注册完成后,请将注册信息打印,并同健康表及支票一同寄交本中心。

* Registration : $20.00 non-refundable fee of each family and tuition of first month are required at registration time, due with the enrollment form.
* All checks/money orders are to be made payable to ACS Education

* Changes in schedules are only accepted with a 2 week advance notice
*Mail to us: 25 Vinal Ave, Edison, NJ 08817

Student's Information
First Name*
  Last Name*
  Chinese Name
 
School*
Teacher
 
Pickup Address*
Zip Code*
 
Date of Birth(mm/dd/yyyy)*
  Gender*
Male  Female
  Grade*
 
Home Address*
 
City*
  State
New Jersey
  Zip*
 
Home Phone*
  Cell 1
  Cell 2
 
Email 1*
Email 2
Mother/Guardian's Name*
Father's Name
In case of Emergency, contact person*
Relation
Contact Phone*
  Contact Cell
     
 
After School Program and Special Holiday Care Program
Days per weekFee per monthSpecial Holiday Care
5$300.00$30.00/day
4$240.00$40.00/day
3$180.00$50.00/day
Non $60.00/day
 

Check the attendant days per week
Monday Tuesday Wednesday Thursday Friday Special Holiday Care
Start Date(mm/dd/yyyy): 

Other Information
Payment Agreement: • I hereby authorize ACS for the above payment for the ACS After School and Special Holiday Care Program(s).