Xilin Academy Registration Form

(Fields in RED are required)

English Name:

Chinese Name:

Male
Female

Birth Day:

Social Security#:

Home Address:

E-Mail Address:

Home Phone#:

Dad's English Name:
Dad's Chinese Name:

Mom's English Name:
Mom's Chinese Name:

Please Write the Class Code and Name You Want to Register:( Schedule/Fee Lists)

Class Code/Name-1:

Class Fee#1:
$

Class Code/Name-2:

Class Fee#2:
$

Class Code/Name-3:

Class Fee#3:
$

Class Code/Name-4:

Class Fee#4:
$

Class Code/Name-5:

Class Fee#5:
$

First Time Registration (y/n):

One Time Registration Fee:
$

Comments:

Notes:

For questions please call Xillin Office at 630-355-4322
There is one time registration fee of $20 for every new student. Students who dropped out of school and re-enroll again in future will be considered as new students.
Send an e-mail to webinfo@xilin-cod.org for general questions
Online information is available at http://www.xilin.org
Xilin offers NO observation of the class for new students
New students need a note from the office to teacher in order to start the first class
There is no refund or discount if a student misses any classes
If a student registers on or before the 8th week, full price applies (Weekend Program only)
If a student registers on or after the 9th week, half price applies (Weekend Program only)
If a student drops a class on or after the 2nd week, no refund
Dance class has one observation allowed, but no refund after registration