YingHua in Beijing Online Registration (Second Round Registration)
Please use this form to submit supplementary information for the summer program.
Student Name
(Last, First)
Student's Name in Chinese
Current Study School
Arriving Date in China
Departing Date from China
Camp Starting Date
Camp Ending Date
Airport Pickup Information
(YYYY-MM-DD HH:MM AM/PM, Airline, Flight#)
Airport Dropoff Information
(YYYY-MM-DD HH:MM AM/PM, Airline, Flight#)
Passport Information (country, passport number) passport expiration date
Flight confirmation number if available Visa number, if any
Roommate preference T-shirt size(S/M/L)
Religion Chinese Ancestry (in province and town, if known)
Parent/Guardian's Emergency Phone Non-parent Emergency Contact in U.S. or China
(Name, Phone, and Relationship)
U.S. Physician Info
(Name and Phone)
Which nights your child will be signed out, if known?
Who are authorized to visit & sign out your child? (Name & Relationship) Allergies & Severity (Bee sting, peanut/nut,
pollen, plants, drugs, foods, other)
Past Medical History Current Medical Condition
Medications (medicine and usage) Over-the-counter medicine brought to the camp (medicine names)
Have your child had Hepatitis A Shot? (highly recommended) Yes
Can we use photos with your child in it on the website? (photo with general information: age, first name, city, etc.)No (your child will be excluded from all group photos as group photos are routinely posted online)
Has your child submitted an essay? (Y/N)** Yes
Have you signed and returned the Release of Liability?* Yes
Please provide additional information, if any
* If no, please sign and mail the Release of Liability to YingHua Language School, P.O. Box 3004, Princeton, NJ 08543-3004; or e-mail a scanned copy to yib@yinghua.org.

** If no, please ask your child to email an essay of 100 words or more (in English or Chinese) to yib@yinghua.org. The subject should be 1) why I wanted to go to "YingHua in Beijing" Summer Language & Leadership Institute", and 2) why I should be accepted by the program. This essay is required.