Submit Student Application Form
 
Audio Video Photo Release Form
Audio Video Photo Release Form (Spanish)
Student Consent Form
Student Consent Form (Spanish)
Student Cover Letter for Consent
Program:

Illinois

 Chinese School:

Cooperative Chinese Language School

School Site:

District 203 - Washington Junior High School

Last Name: Middle Name:
First Name: No Absent Commitment:
Email:  (will be used as student login)
Password: (not to use your email password)
Gender: Phone:
Birth Place: Birth Date
Home Address:
City: State: Zip: 
Current School: Returned "STARTALK" Student?
Current Grade: Home Internet Access?
Learning Chinese: Years Speak Chinese at Home:
Class Code: (Select your preference if Class Code is applicable)
Travel Plan during this summer:  
Please identify your ethnic groups (you may select two):
      
[Parent] Last Name: First Name:
Phone: Email:  
Contact Doctor: Doctor Phone:
Agreement
Do you agree to grant irreversibly the Cooperative Chinese Language School and the STARTALK program’s sponsors the right to use and reproduce any and all photographs, video clips, and/or audio clips taken of me in any form for use in STARTALK’s and school’s newsletters, brochures, web sites, flyers, and in any other publications produced for the aforesaid school and all sponsors of the STARTALK program. I waive the right to inspect or approve the finished version(s) of such images including written copy that may be created in connection therewith. Content is also granted for any use of my name in any part of those publications listed above?
I certify that all statements made herein are true and correct. I also declare that the above named student is in good physical condition and has medical insurance coverage. In case of illness or accident, the sponsors have my authority to secure necessary medical attention. I will release the sponsors and their officers, directors, agents, activity sponsors, teachers, and/or volunteers from any and all liabilities arising out of the student’s participation in this program, and also further agree to indemnify and not hold responsible the sponsors and their officers, directors, agents, activity sponsors, teachers, and/or volunteers for any losses, damages, costs, or expenses caused directly or indirectly by either the actions of the student or any staff of involved organizations in this program. In case of medical aid rendered, I will reimburse sponsors for medical and other expenses incurred in his/her case. And, I understand that there may be unknown risks involved in this activity. I am hereby waiving all claims/suits against the sponsors or their authorized persons, officers, agents, and/or schools for, but not limited to, illness, injury, or death occurring in the duration of this program.
Accept JPG or PDF file type and file size can't over 500 Kbyte
The upload forms are located on the left column of this page.
You may do this upload later using your above email address and password to login your student account by clicking "login" at the top menu bar.
Upload Audio Video Photo Release Form:
Upload Student Consent Form:

     

If there is no response after you clicking the [Submit] button, please check and complete all the * items.

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