APPLICATION FORM
Application Checklist:
¡õ Signed application form
¡õ Signed terms and agreement
¡õ Deposit of US$400 payable to GCE
Summer Camp Program £º |
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Student Information: |
First Name |
Last Name |
Chinese Name if Applicable |
E-mail |
Date of Birth: |
Male / Female |
Address |
City |
State |
Zip code |
Country |
Place of Birth |
Phone (H) ( ) ( )
country city |
Phone (W) ( ) ( )
country city |
Fax ( ) ( )
country city |
Nationality |
Passport No |
Native language |
History of Illness: |
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Name of Medical Insurance Carrier: |
Program options (circle one or both): July 14 to July 27, 2008/July 28 to August 10, 2008 |
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School Information |
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School Name: |
Current Grade : |
Expected Date of Graduation: |
Street No. |
Telephone: |
City |
State |
Zip Code |
Country |
Circle the most appropriate number of Chinese words you know: None (Total Beginner) / Approx. 300 / Approx. 800 / Approx. 1500 / Approx. 2500 / Approx. 3500 |
Parent / Guardian Information :#1 |
First Name: |
Last Name: |
Chinese Name: |
Relationship to Student (eg:father): |
Address: |
City: |
State: |
Zip Code: |
Country: |
Home Telephone: |
Business Telephone: |
Email Address: |
Parent /Guardian Information :#2 |
First Name: |
Last Name: |
Chinese Name: |
Relationship to Student: |
Address: |
City: |
State: |
Zip Code: |
Country: |
Home Telephone: |
Business Telephone: |
Email Address: |
How did you hear about this program?
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Accommodation: |
Hotel: |
Homestay: |
Campus: |
Date Application Fee(US 400$)was paid (e.g.Feb 20) |
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Paid by: Bank transfer/ Certified Bank Check/ Money order |
Name of Bank: |
I agree that:
1) The above information is true and documents given in support of my Application are complete and correct. 2) I will abide by the laws of the People's Republic of China and will not engage in activities that bear no relation to my academic pursuit in China.
Signature :
(parent or Guardian) Date |
Comprehensive information on GCE's Program, Fees, Features and How To Apply guide is available at www. globalchineseedu.com.
For general questions, e-mail info@globalchineseedu.com
For questions regarding application, e-mail admission@globalchineseedu.com
OR contact your nearest GCE Office. |
Supplemental Information:
Are there any special travel arrangements you would like to make before/after the program? (e.g: learn Chinese language in China)
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How did you hear about the program?
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Guidelines:
- Students are expected to attend every class and session of program activities.
- All private outings outside the university campus are subject to prior approval of the program director.
- No student will be permitted to leave the campus after 10 pm, except in a program event accompanied by GCE staff.
- Any behavior that is insulting to the host country or harmful to the program will not be tolerated.
- GCE is not responsible for any loss or damage of personal property.
- In case of surgical or medical emergency, the parent hereby gives permission to the physician selected by the program director to hospitalize, secure proper treatment for, and order injection, anesthesia or surgery for the student. The parent or guardian is responsible for all fees incurred.
- If for any detrimental behavior or conduct, the student may be expelled or dismissed from the program. No refunds will be made.
Medical Insurance:
Medical insurance must be purchased for the entire program. If the student already has a medical insurance policy in place, please make sure the coverage is applicable in China. We can recommend an insurance provider for the student but the terms and costs of the insurance should be addressed directly to the insurance company.
Passport and Visa:
Students will need to have a valid passport with at least 6 months validity before expiration date. Students without a valid passport should apply as soon as possible. All students will need to have a valid tourist Visa to enter China. You can apply for your tourist visa in Chinese Embassy or Consulate in your country.
Cancellation and Refund:
Program Fee $2,000 per session
Amount Enclosed:
Total Due:
- If written cancellation is received 50 days or more prior to departure, all but $300 will be refunded.
- If written cancellation is received 31-49 days prior to departure, all but $500 will be refunded.
- If written cancellation is received within 30 days of departure, there will be no refund
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CERTIFICATION
I AGREE TO THE TERMS & CERTIFY THAT THE INFORMATION DISCLOSED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE
Student Signature: Date:
Parent Signature: Date:
Terms and Agreement:
I undersigned (or my parents or guardian if I am a minor), an applicant for a program of GCE, acknowledge that the terms and conditions appearing in the program brochure or itinerary description constitute part of my agreement with GCE, including sections concerning responsibility, refunds and changes in dates, accommodations and courses.
I waive and release all claims against GCE and its agents, including any person or entity employed or utilized by GCEt and host schools in China for any injury, loss, damage, accident, delay or expense resulting from events beyond its control,including (without limitation) acts of God, war, strikes, incidents of politically-motivated violence, sickness or quarantine, government restrictions or regulation or, in the absence of its own negligence, arising from the use of any vehicle or from the selection or any act or mission of any host family, steamship, airline, railroad, bus company, taxi service, hotel, restaurant, school, university or other firm, agency, company or individual.
I understand that I am responsible for exercising caution and common sense at all times to avoid injuries. I understand GCE is providing as part of my program fees limited travel accident and sickness insurance coverage for my benefit, in event of injury or illness while on a GCE-sponsored program. I further understand that GCE is not responsible for any injury or loss whatever suffered by me during periods of independent travel or during any absence from the university or other GCE-supervised activities. I expressly acknowledge and agree as a condition of traveling on a GCE program that I (and anyone claiming through me) shall have no rights whatsoever, directly or indirectly, under any theory at law or in equity against GCE except (i) for refunds in the circumstances described here, and (ii) to the same extent (including deductibles, exclusions and maximum limits) that such claims are covered and amounts are actually paid under insurance policies included by GCE for my benefit with the GCE program. I understand GCE has obtained this insurance to provide alternate coverage for me instead of, and in place of,any rights or claims I may otherwise have against GCE or related persons.
I hereby grant GCE and its agents full authority to take whatever actions they may consider to be warranted due to any international or political unrest, personal emergency or other event regarding my health and safety, and I fully release each of them from any liability for such decisions or actions as may be taken in connection therewith. I authorize GCE and its agents at their discretion to place me at my own (or my parents') expense and without my further consent in a hospital within or outside my country for medical services and treatment, or if no hospital is readily available, to place me in the hands of a local medical doctor for treatment. If deemed necessary or desirable by GCE or its agents, I authorize them to transport me back to my country by commercial airline or otherwise at my own (or my parents') expense for medical treatment.
commercial airline or otherwise at my own (or my parents') expense for medical treatment. In the event GCE or its agents advance or loan any monies to me or incur special expense on my behalf while I am abroad, I (and my parents) agree to make immediate repayment upon my return. I will comply with GCE's rules, standards and instructions for student behavior. I hereby waive and release all claims against GCE and its agents arising at a time when I am not under the direct supervision of GCE or its agents or arising out of my failure to remain under such supervision or to comply with such rules, standards and instructions, and I agree to indemnify GCE and its agents against any consequences thereof. I agree that GCE shall have the right to enforce appropriate standards of conduct and that it may at any time terminate my participation in GCE's program for failure to maintain these standards or for any actions or conduct which GCE considers to be incompatible with the interest, harmony, comfort and welfare of other students. If my participation is terminated, I consent to being sent home at my own (or my parents') expense with no refund of fees. I also understand that, if I leave the program voluntarily for any reason, there will be no refund of fees already paid. On group tours or other activities arranged by GCE I will accept the will of the majority whenever a matter of choice is presented to the group. I will also accept in good faith the instructions and suggestions of GCE or its agents in all matters relating to GCE's program or the personal conduct of program participants. I understand that from time to time GCE's publicity material may include statements by its students and/or their photographs, and I consent to such use of my comments and photographic likeness. I further agree to the release of my name and contact to other future participants. I understand that GCE reserves the right to make cancellations, changes or substitutions in cases of emergency or changed conditions or in the interest of each group. If I am not a citizen of the United States or Canada, I understand and accept that it is my responsibility to obtain all visas and required documents as a result of my not being a U.S. or Canadian citizen. I shall hold GCE harmless in the event I cannot obtain the necessary documents for participation. All references in the Agreement and Release to "GCE" and "its agents" shall include GCE and all of its officers, directors, staff members, campus directors, chaperones, group leaders, teachers, host school or school officials, employees, agents and affiliated companies. All references herein to the "parents" of the applicant shall include the legal guardian or other adult responsible for the applicant. This agreement will be effective when my application is accepted by GCE. I understand that my agreement with GCE cannot be modified or interpreted except in writing and that no oral modification or interpretation shall have any validity.
Agreed and accepted by:
| STUDENT SIGNATURE: |
DATE |
| PARENT SIGNATURE: |
DATE |
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In the event GCE or its agents advance or loan any monies to me or incur special expense on my behalf while I am abroad, I (and my parents) agree to make immediate repayment upon my return. I will comply with GCE's rules, standards and instructions for student behavior. I hereby waive and release all claims against GCE and its agents arising at a time when I am not under the direct supervision of GCE or its agents or arising out of my failure to remain under such supervision or to comply with such rules, standards and instructions, and I agree to indemnify GCE and its agents against any consequences thereof. I agree that GCE shall have the right to enforce appropriate standards of conduct and that it may at any time terminate my participation in GCE's program for failure to maintain these standards or for any actions or conduct which GCE considers to be incompatible with the interest, harmony, comfort and welfare of other students. If my participation is terminated, I consent to being sent home at my own (or my parents') expense with no refund of fees. I also understand that, if I leave the program voluntarily for any reason, there will be no refund of fees already paid. On group tours or other activities arranged by GCE. I will accept the will of the majority whenever a matter of choice is presented to the group. I will also accept in good faith the instructions and suggestions of GCE or its agents in all matters relating to GCE's program or the personal conduct of program participants. I understand that from time to time GCE's publicity material may include statements by its students and/or their photographs, and I consent to such use of my comments and photographic likeness. I further agree to the release of my name and contact to other future participants. I understand that GCE reserves the right to make cancellations, changes or substitutions in cases of emergency or changed conditions or in the interest of each group. If I am not a citizen of the United States or Canada, I understand and accept that it is my responsibility to obtain all visas and required documents as a result of my not being a U.S. or Canadian citizen. I shall hold GCE harmless in the event I cannot obtain the necessary documents for participation. All references in the Agreement and Release to "GCE Company" and "its agents" shall include GCEt and all of its officers, directors, staff members, campus directors, chaperones, group leaders, teachers, host school or school officials, employees, agents and affiliated companies. All references herein to the "parents" of the applicant shall include the legal guardian or other adult responsible for the applicant. This agreement will be effective when my application is accepted by GCE Company. I understand that my agreement with GCE cannot be modified or interpreted except in writing and that no oral modification or interpretation shall have any validity.
Agreed and accepted by:
| STUDENT SIGNATURE: |
DATE |
| PARENT SIGNATURE: |
DATE |
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