EmailMe Form - Oakland Asian Cultural Center

Date Time (日期） *

MM / DD / YYYY

Name （姓名） *

First Last

Gender （性別） *

Male （男性）

Female （女性）

Ethnicity （種族） *

Age （年齡） *

Date of Birth （出生日期） *

Address （地址） *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone （聯絡電話） *

### - ### - ####

Email （電郵郵址） *

Preferred Method of Communication （首選聯絡方式） *

Email

Mail

Phone

Class Information （課程資訊）

Class （課程名稱） *

Time （時間）

Day （星期幾）

Adult students shall hold all instructors & OACC harmless from any and all damages and injuries during classes and performances at all time. By typing your name below, you are agreeing to these terms.

General Policies:
* All classes are catered on a first come first serve basis.
* You must complete and sign workshop registration form to participate in any OACC class or workshop.
* If you miss a class, you may make it up (subject to class instructor's discretion) but no refund will be given.
* OACC reserves the right to cancel class that does not meet the minimum enrollment.
* OACC has the right to cancel classes in case of emergencies that would compromise our student's safety.

Payment Policies:
* If you are taking a monthly class, payment is due on the first class date of each month.
* If you are late with class payment, a $10 late charge will be added.
* You will not be able to attend class if tuition is not paid.
* Please turn in all class payments to OACC front desk.
* All payments must be made by cash, credit card, or check.
* Please make check payable to Oakland Asian Cultural Center (OACC).
* All payment is final, no refunds.

Penalty Charge:
A $25.00 fee will be charged on returned check and "payment stopped" check.
（任何人在使用本文化中心之樓宇範圍內或表演時，無論如何均不得向本中心及教師們提出控訴或要求受傷賠償。本中心及教師絕無任何刑事及民事責任。

課程條例：
＊所有課程都按先到先得註冊條例。
＊如要參加本中心任何課程或講習班，均必須填寫簽署報名表。
＊如果您錯過一堂課，您也許可以補課，但須經由課程老師決定，但都將不會退學費。
＊本中心將保留取消未達到最低報名學生人數的課程的權利。
＊本中心保留為維持學生安全，取消課程的權利。

付款條例：
＊如果您上的是每月一次的課程，學費需在每月第一堂課時繳清。
＊若您遲付學費，將繳交$10遲付款費。
＊若學費未繳，將無法上課。
＊請在本中心櫃台繳付學費。
＊本中心接受現金、信用卡及支票付費方式。
＊若使用支票，請開給：Oakland Asian Cultural Center。
＊所有繳費均無退款。

罰款條例：
＊若您的支票退票或停止付款，本中心將加收$25.00手續費用。

I have read and will comply with the above General Policies, Payment Policies and Penalty Charge. （我已閱讀並瞭解上述所有條款，並認同。） *

Signature （簽名）

Date （簽名日期）

Emergency Contact （緊急聯絡人）

Emergency Contact Name （緊急聯絡人姓名） *

Emergency Contact Relation to Student （緊急聯絡人與學生的關係） *

Emergency Contact Phone Number （緊急聯絡人的聯絡電話號碼） *