Name of Parent 1 *
Name of Parent 1
Name of Parent 2
Name of Parent 2
Cell Phone *
Cell Phone
Home Phone
Home Phone
Home Address *
Home Address
Name of Child *
Name of Child
Date of birth *
Date of birth
Child Chinese Language Background *
Speaking Ability *
Listening Ability *
Reading and Writing Ability *
How do you learn about our program?
By checking this box, you as a family agree all the terms and conditions listed in the Code of Conduct of CCPC. *
Photo consent of your child whilst learning/ working/ playing at CCPC. *