Year 2024-2025 The Registration of Tzu Chi Academy, Chicago

芝加哥慈濟人文學校 Tzu Chi Academy, Chicago

2024-2025 學年學生註冊表格 / 2024-2025 School Year Student Registration Form
註冊前請詳閱芝加哥慈濟人文學校網站上之註冊須知及註冊注意事項 (Please read the registration rules and process on Tzu Chi Academy Chicago's registration page before registration)
在校生或新生 /Current Student or New Student*
新註冊中文班級 / Enrolling Class:*
Student Name*

First NameLast Name
學生姓名 / Student Chinese Name

中文姓中文名
出生日期 Date of Birth （只限 08/31/2021 前出生/ For birthdate on or before 08/31/2021）：*

MonthDayYear
性別 Gender:*

男生 Male女生 Famale
是否為同一家庭第三個小孩註冊本校? / Have you finished the registration of two children and are you registering the 3rd child of the same family?
住址 Address:*

Street Address

Street Address Line 2

CityState

Zip Code
聯絡電話/Contact Phone
Parent or legal guardian :*

First NameLast Name
父母或法定監護人 :

中文姓中文名
關係 / Relationship: *
手機號碼 Cell Phone:*
If no available, please fill in 000-000-0000
E-mail:*
if no available, please fill in example@example.com
Parent or legal guardian :*

First NameLast Name
父母或法定監護人 :

中文姓中文名
關係 / Relationship: *
手機號碼 Cell Phone:*
If no available, please fill in 000-000-0000
E-mail:*
if no available, please fill in example@example.com

2024/2025 年免責任就醫授權書

Medical Release

假如發生意外事故並且人文學校聯絡不到您，請將兩位可以代您關照而且替您的小孩負責就醫的親戚或朋友的名字寫出來。

Should your child be hurt in an accident and we are unable to contact you, please list the names of two individuals who will take responsibility in seeking medical attention.
1st 緊急聯絡人 / Emergency Contact:*

First NameLast Name
關係 / Relationship *
手機號碼 Cell Phone:*
2nd 緊急聯絡人 / Emergency Contact:*

First NameLast Name
關係 / Relationship *
手機號碼 Cell Phone:*
醫生姓名 Doctor Name:*

First NameLast Name
手機號碼 Cell Phone:*
倘若您所填的資料有任何變更，請儘快通知人文學校，假設發生意外事故而且人文學校不但聯絡不到父母親，也無法聯絡到父母親所指定的其他負責人，則人文學校有權替學生採取緊急就醫措施，學生家長不能有任何的異議。

Should there be any changes in the above information, please inform the school immediately. If the Tzu-Chi Academy is unable to contact both the student's parents and those persons designated above, it has the authority to seek medical attention for the student with no objection from the student’s parents.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

1. I hereby acknowledge that I have voluntarily applied for my child to participate in all activities to be conducted by the Buddhist Tzu Chi Foundation (“BTCF”). I agree to defend, indemnify and save harmless, BTCF and its officers, chaperons, teachers, volunteers, employees, and other persons associated with BTCF from and against any and all claims, demands, losses, defense costs, or liability of any kind or nature which the BTCF, its officers, chaperons, teachers, volunteers, employees and other persons associated with BTCF may sustain or incur or which may be imposed upon them for injury to or death of persons or damage to property as a result of, arising out of, or in any manner connected with my child’s participation in all BTCF’s activities.

2. I certify that my child has the necessary skills and abilities to participate in all BTCF activities and I assume full responsibility for body injury, loss of personal property, and expenses thereof as a result of my child’s negligence in participating in BTCF activities. I also agree to instruct my child to abide by the rules or instructions given to them either verbally or in writing by BTCF. I further understand that BTCF reserves the right to refuse any person judged to be physically or mentally unfit to meet the rigors and requirements of participating in certain activities. I also agree that BTCF may use video or photographic or audio records of the activities that my child has participated in for promotional purposes.

3. I also agree that in the event of illness or accident of my child, any BTCF officers, chaperons, teachers, volunteers, employees, and other persons associated with BTCF, in whose care my child has been entrusted, is are authorized to consent to an X-ray examination, anesthetic, medical or surgical diagnosis of my child; to transportation of my child to any hospital and to treatment and hospital care to be rendered to my child under the general or special supervision and upon the advice of a licensed physician and/or surgeon. I hereby indemnify, discharge and hold harmless BTCF, its officers, chaperons, teachers, volunteers, employees and other persons associated with BTCF from liability because of the exercise of such actions.
Child's Name of Consent:*

First NameLast Name
Parent / Legal guardian's Name:*

First NameLast Name

2024-2025 SCHOOL YEAR

Opt-Out Media Release Form
If you do not want your child to be photographed, videotaped and/or audiotaped, during school-sponsored activities, learning experiences, and/or media events, please complete the Opt-Out Media Release Form and email a copy of the signed form to academy_chicago@tzuchi.us.

Chick Here for the Opt-Out form

  PARENT/GUARDIAN CONSENT

The Tzu Chi Academy’s Parent/Student Handbook and related rules and policies are made available on our website at https://tzuchi.us/academy/chicago for all students and parents. The school asks that you take time to review the contents as a family before registration. It is the expectation of the school that all students and families will adhere to the policies and procedures as they are intended for the good of all students. Should you have any questions about the Parent/Student Handbook, please do not hesitate to contact our administration team.

Below are some of the important rules (Please refer to the school web site for the complete rules):

1)    Student must follow class rules and school rules. Student must wear uniform properly and should dress neatly.

2)    Student must arrive at class on time. If there are any special reasons that he/she cannot attend the class or need to leave early, parents must call to inform the teacher in advance.

3)    Please respect all school property and belongings. You will be responsible for any damages caused and will need to pay for any expenses incurred.

4)    Parents have the obligation to serve as classroom parents (to assist the teacher) and as school parent volunteers.

5)    Classroom teachers have full authority to oversee / assign duties for classroom parents. Parents will only be allowed to be in the classroom if requested by the teachers to assist with class materials, or under special circumstances, as permitted by the teachers. Parents are invited to stay at the rest area during class time, and not the classroom hallway as noise can distract the students.

6)    In order to not disturb students and to protect the rights and privacy of all students and staff, parents are not allowed to take pictures or videotape during lesson time. Parents can take pictures during non-class hours or big school events (such as New Year celebration, Mother’s day, graduation ceremony, etc.) provided that it will not affect/disturb the events.

7)    There will not be make-up classes for any cancellations due to force majeure (any circumstances beyond the control of the school, such as inclement weather).

8)    If student, parents or guardians refuse to comply with school rules, the school has the right to expel the student.

9)    Most of the textbooks and teaching materials used are protected by copyright. If parents plan to use or share the materials, please obtain the required authorization in advance to make sure you are not violating the intellectual property rights. If you plan to share any pictures or video containing people other than your family on the Internet or to the public, please make sure you obtain the permission from the school, staff and the parents in advance in order to avoid violating the right of publicity and the right of privacy.

I have reviewed the students/parent handbook and the above, and agree to comply with them.
Child's Name of Consent:*

First NameLast Name
Parent/ Legal guardian's Name :*

First NameLast Name

請留意以下須知 / Please note the following details:
請在以下勾選您要的才藝班選課項目

PLEASE "CHECK" ITEMS BELOW FOR YOUR EXTRACURRICULAR CLASS SELECTION
如果您的才藝班已額滿，請選擇您想要候補的才藝班 / If your first desired choice of extracurricular class is full, please select the class you want to be on the waiting list.*
1) 一學年費用(包含學費、作業費、及才藝班基本學費，但不包含才藝班材料費用及$20註冊手續費)。

Tuition and Fees (includes the tuition, homework material fee, and basic extracurricular tuition but does not include applicable extracurricular material fee and $20 registration fee).
- $600/student a year, or
- $450/student a year (Only for students in Pre-K and Kindergarten who choose not to register for an extracurricular class)
2) 學校會提供每位學生一份學費明細給家長，最終的金額會以學校提供的繳費單為主。家長在確認學費明細後，再將正確金額的支票交給註冊組。

School will provide an invoice with the fee breakdown for each student. Final total amount will be based on the invoice provided by the school. After confirming the tuition breakdown, parents will then write a check with correct amount to registration team.

上課地點 School Location: Prairieview School, 699 Plainfield Rd., Downers Grove, IL 60516

上課時間 Class hours: 星期日 Sundays 1:00PM - 4:30PM

學校網站: https://tzuchi.us/academy/chicago
芝加哥分會會所地址Tzu Chi Office: 1430 Plainfield Rd., Darien, IL 60561 TEL: (630)963-6601
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芝加哥慈濟人文學校 Tzu Chi Academy, Chicago

註冊前請詳閱芝加哥慈濟人文學校網站上之註冊須知及註冊注意事項 (Please read the registration rules and process on Tzu Chi Academy Chicago's registration page before registration)

2024-2025 SCHOOL YEAR

Opt-Out Media Release Form
If you do not want your child to be photographed, videotaped and/or audiotaped, during school-sponsored activities, learning experiences, and/or media events, please complete the Opt-Out Media Release Form and email a copy of the signed form to academy_chicago@tzuchi.us.

芝加哥慈濟人文學校 Tzu Chi Academy, Chicago

註冊前請詳閱芝加哥慈濟人文學校網站上之註冊須知及註冊注意事項 (Please read the registration rules and process on Tzu Chi Academy Chicago's registration page before registration)

2024-2025 SCHOOL YEAR

Opt-Out Media Release FormIf you do not want your child to be photographed, videotaped and/or audiotaped, during school-sponsored activities, learning experiences, and/or media events, please complete the Opt-Out Media Release Form and email a copy of the signed form to academy_chicago@tzuchi.us.

Opt-Out Media Release Form
If you do not want your child to be photographed, videotaped and/or audiotaped, during school-sponsored activities, learning experiences, and/or media events, please complete the Opt-Out Media Release Form and email a copy of the signed form to academy_chicago@tzuchi.us.