REGISTRATION FORM E INTENSIVE KOREAN (SPOUSE VISA)

ID #: REF#:

YEAR: 2017 JAN 24 - MAY 18 (144 hours)

FULL NAME (last name, first): NICKNAME: BIRTHDATE: CIVIL STATUS:
(MM/DD/YYYY) SINGLE
MARRIED
PHOTO
(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
INTENSIVE KOREAN
Beginner, 1A* 16 years old P 2,000.00
(Jan 24 Mar 16) T,W,TH 9AM-12NN
INTENSIVE KOREAN LEE YOUNG HEE
Beginner, 1B* 16 years old P 2,000.00
(Mar 28 May 18) T,W,TH 9AM-12NN
*Students must pass both 1A and 1B in order to obtain the Language Proficiency Certificate
HISTORY OF KOREAN LANGUAGE (leave blank if not applicable)
NAME OF INSTITUTION &
DATES 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 students 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/land line
1.
2.
Allergy/other necessary information: Students 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 Centers rule to bring complete requirements namely Accomplished Registration Form, (1) Passport-sized photo, (1)
Photocopy of Valid ID. 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 persons 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).

Students 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 wards 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.

Guardians signature: __________________________ Date:_____________

PRINTED NAME