Fax-in or Mail-in

 Please click PRINT button on menu bar to print the following from. 

By filling out the Summer Program Registration Form (below) and paid the fee, I and my child agree to and abide by the following registration terms and rules:

  1. There will be no refund once the fee is paid but the amount paid can be used in lieu of other courses or be transferred to other person on or before August 31, next year.
  2. I waive any claims or damages of any sort against the Ho Math and Chess Learning Centre and its affiliates, all staff in connection with my child's activities.
  3. I agree that any pictures or video taken with my child's image during the course of program can be used as promotion or advertisement in relation to the program with no children's names identified.
  4. Student whose conduct is disruptive, or disturbing may be asked to withdraw and the parent, child or guardian all agree to abide to the decision made. In this case, the fee not  used will be prorated and then refunded.
  5. The summer program reserves the right to adjust course contents or change instructors; combine or cancel courses if deemed necessary.
  6. NSF cheques or declined credit card will be charged with $25 administration fee.

I authorize my credit card to be charged for the amount indicated and I understand it will be processed using PayPal secure system and this credit information will be shredded immediately once the amount is charged.

Summer Program Registration Form

Use one form per child registering. Only completed from with payment or credit card information will be processed.

(Fax to: Vancouver 604-266-0974)

(Mail this form along with cheques (payable to Math and Chess) to Ho Math and Chess Vancouver office at 2586 Waterloo Street, Vancouver, BC, V6R 3H5, Canada )

Credit card type (if paying by credit card)

Master card or Visa (circle one)

Credit card number (if paying by credit card)  
Confirmation code (back last 3 digits) (if paying by credit card)  
Expiration date (if paying by credit card)  
Name shown on the card (if paying by credit card)  
Address and postal code (if paying by credit card)  
email address (if paying by credit card)  
Home address (if paying by credit card)  
Amount charged (if paying by credit card)  
Child's full name (must fill out)  
Child's sex (must fill out)  
Child's age (must fill out)  
Entering grade in September (must fill out)  
Resident address (must fill out)  
Resident phone number (must fill out)  
Cell phone number (must fill out)  
Special consideration: medication, allergies, disabilities, language etc... (must fill out)  
Course # registered (enter courses numbers) (must fill out)  
Choice of course location (must fill out)  
Choice of course time (must fill out)  
Emergency contact person (other than parents/guardian) and phone number (must fill out)  

 

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