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).