enrolment-test - Academia Concept Educational Centre

Online Registration Form – 2022-2023

Step 1 of 2

Student Information

Student Name(Required)

First Last

Chinese Name

Birthdate(Required)

Gender

Male

Female

Address(Required)

City

Postal

Day School Name

Day School Grade @ Sept 2022(Required)

Allergies / Medical Condition

Type “NONE” if no allergies and medical condition

Primary Contact Information

Name(Required)

First Last

Phone(Required)

Relationship

Email(Required)

Emergency Contact Information

Name(Required)

First Last

Phone(Required)

Relationship

COURSE REGISTRATION

In-Person Enrichment Course Registration: September 2022 to May 2023 (28 classes). Please register using student grade as of Sept 2022

Chinese – Cantonese & Mandarin

Select Grade

Advanced English

Select Grade

Comments

Combo Discount

$ 0.00 CAD

Total

Terms & Condition(Required)

I understand all fees paid are non-refundable.

I understand all courses will take place in-person at 100 York Blvd, Richmond Hill, ON

I have read this application thoroughly and all the information provided is true and valid. I hereby release and forever discharge Academia Concept (“ACEC”), all employees and agents thereof from any and all liability of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen. I agree to permit my child’s photo/video to be taken for program uses.

For the 2022/2023 Enrichment Program – ACEC will review actual enrollment by August 31st, 2022 – if any of the registered courses above cannot start due to lack of enrollment (at the discretion of ACEC) a refund will be given.

There are no make-up classes, and there are no refunds for absence regardless of the reason.

I understand registering online does not guarantee placement into the program. Placement is only guaranteed once we accepted your full payment.

I agree to the Terms of Service

Payment Method(Required)

Cheque

e-Transfer

Cash

Credit Card (via PayPal)

(If you select Credit Card by mistake, you will not be able to change the payment method back; please re-submit a new form)

Credit Card Payment (via PayPal)

You will be redirected to PayPal for a secure credit card payment. PayPal account is NOT required to make payment. You can pay directly using your credit card. Academia Concept will not store your credit card information.

Confirm to pay via credit card with PayPal

Payment Method

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