REGISTRATION FORM A2 – ELEMENTARY/INTERMEDIATE KOREAN LANGUAGE

ID #: REF#:

YEAR: 2018 TERM: 1st (JAN 22 – APR 14 )

FULL NAME (last name, first): NICKNAME: BIRTHDATE: CIVIL STATUS:
(MM/DD/YYYY)  SINGLE
PHOTO  MARRIED
(passport size taken LANDLINE: MOBILE NUMBER:
within the last 3
PRESENT ADDRESS:
months)

NATIONALITY: EMPLOYER/COMPANY / SCHOOL:

E-MAIL ADDRESS: ID PRESENTED:

DO YOU WANT TO BE PART OF OUR MAILING LIST?
 YES  NO
If yes, please check which type of emails you want to receive from us (check all that apply)
 KCC Newsbytes  Korean Embassy Newsletter  KCC Events Announcements
HOW DID YOU FIND OUT ABOUT KCC?
 Internet  School/Work
 KCC Homepage (www.koreanculture.ph)  Newspaper
 Facebook (KoreanCulturePH)  Magazines
 Twitter/Instagram (@KCCPhil)  Others (Please specify): ________________________
 Family/Friends
PURPOSE FOR STUDYING KOREAN:
 Business/Employment  Hobby/Interest
 Academic  Others (Please specify): _______________________
CHOOSE YOUR CLASS SCHEDULE
CLASS
SECTION TEACHER DAYS MIN. AGE PUT A CHECK
MATERIALS FEE
Elementary Korean 1 (E1)
Elementary 1-A Kim So Young MW, 9am-12nn
Elementary 1-B Bang Cecilia MW, 1pm-4pm
16 years old P 2,500
Elementary 1-C Lee Young Hee TTH, 1pm-4pm
Elementary 1-D Jung Jongsu TTH, 6pm-9pm
Elementary Korean 2 (E2) - should have passed E1 and/or TOPIK Level 1 + Diagnostic Exam
Elementary 2 Lee Young Hee TTH, 9am-12nn 16 years old P 2,500
Intermediate Korean 2 (INT2) – should have passed INT1 and/or TOPIK Level 3 + Diagnostic Exam
Intermediate 2 NOH OK JIN TTH 6pm-9pm 16 years old P 3,000
HISTORY OF KOREAN LANGUAGE (leave blank if not applicable; write year and term for old KCC students)
NAME OF INSTITUTION &
DATE ATTENDED TEXTBOOKS USED TOTAL # OF HOURS
INSTRUCTOR

In case of self-study, please provide details as to how much you know of Korean Language.
 ACCIDENT WAIVER AND RELEASE OF LIABILITY
This form must be read carefully, completely filled out and signed by the student
(or the student’s guardian enrolled) in the Center (no faxed or photocopied signatures).

Emergency Contact Person/s: (Please list down at least two people.)

Names Relation Mobile number/Landline
1.
2.
Allergy/other necessary information: Student’s BLOOD TYPE:

In consideration of my voluntary application and participate in the class programs of the Center, I acknowledge that I am under the
tutelage of the Korean Cultural Center in the Philippines.

I accept the Center’s rule to bring complete requirements namely Accomplished Registration Form, (1) Passport-sized photo, (1)
Photocopy of Valid ID and Printed Email Ticket (for online registrants only). I acknowledge that KCC will not accept my
registration if my requirements are incomplete.

I acknowledge that the class may involve a test of a person’s physical and mental limits and may carry with it potential risks. I
accept full responsibility for my physical condition and hereby certify that there are no health-related reasons or problems that
preclude my class participation.

I hereby attest that I will not put my health at risk especially at times when I have doubts about my capabilities in completing or
performing the activities in class.

I agree to solely bear all costs of such injury or damage to myself as well as the property damages that I may cause during my stay
in the Center.

I further agree to abide by all the rules and regulations as set forth by the Korean Cultural Center whether written or verbal.

I hereby certify that I have read this document and understand its content (no faxed or photocopied signatures).

Student’s signature: __________________________ Date:_____________

PRINTED NAME

PARENT/GUARDIAN WAIVER FOR MINORS ONLY

(Under 18 years old)

The undersigned parent and legal guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to
his/her child or ward’s participation in all activities or events, and has agreed individually and on behalf of the child or ward to the
terms of the accident waiver, release of liability as stated above.

I certify that I have read this document, and I fully understand its content.

Guardian’s signature: __________________________ Date:_____________

PRINTED NAME