Chinese Culture Experience Program Registration Form

Name as in passport or ID *

First

Middle

Last

English Name/ Name called by/Nickname (optional)

Gender *

ID (Passport number or 身份证) *

Nationality *

Date of birth YYYY/MM/DD *

Age *

Home address *

Phone Number *

Email *

Emergency contact 1 (Name of Father Mother, Spouse, etc.) *

Relationship with Emergency contact 1 *

Phone number of Emergency contact 1 *

Emergency contact 2 (Name of Father, Mother, Spouse, etc.) *

Relationship with Emergency contact 2 *

Phone number of Emergency contact 2 *

Language skills *

Cultural Experience Beijing- PingYao *

Cultural Experience Beijing- Xi'an *

Allergy *

Please notify us of any allergies needing immidiate medical attention and if you have an EPI pen.

If you have severe allergies, please specify:

Dietary restrictions *

If other dietary restrictions, please specify:

Diet preference

VEGAN DIET: You enjoy plant-based foods, but you do not consume meat, seafood, or animal by-products.
VEGETARIAN DIET: You do NOT cansume meat or seafood. Most vegetarians consume eggs and dairy (lacto-ovo vegetarians), but some avoid dairy and consume eggs (ovo vegetarians). Lacto-vegetarians avoid eggs but consume dairy.
FLEXITARIAN DIET: You eat primarily according to vegetarian guidelines. However, you occasionally eat meat and seafood.
No preference. You eat plant-based foods and animal products without major restrictions.
other

Is the participant currently taking any medication? *

Special needs *

If other needs, please specify:

Preferred payment method

Special discounts (Please, provide details in the observations at the end of this form)

If you are applying with a group please specify who you are the campers in your group in the last box “Additional requests”

How did you hear about this event?

Additional requests, observations, questions, etc.?

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