Student Register 08/17/2020 KASEC Program Student Application Programs $ Donation Amount: Choose Your Donation Amount:Harmonia EnsembleInclusive Basketball - CLOSEDGolf Birdie Buddy - TBDDancing Stars - TBDMid-Program RegistrationStudent Information Student's Legal Name * Required Student Nickname Date of birth * Required Grade * Required Gender * Required Gender Male Female Prefer not to say Diagnosis * Required Allergy * Required Any other medical issues? * Required Please be as specific as you can Any behavioral issues? * Required Please be as specific as you can What school program is your child a part of? * Required Please be as specific as you can Are you currently receiving ABA service? * Required Are you currently receiving ABA service? * Required Yes No Student t-shirt size (Adult size) * Required - select - Small Medium Large X-Large Parent / Guardian Legal Name * Required Relationship * Required Relationship Father Mother Legal guardian Other Other Phone Number * Required Email Address * Required Select Payment Method PayPal (Credit Card) Payment Information First Name * Last Name * Email Address * Comment Billing Details Country * United StatesCanadaUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic People's RepublicCongo, Republic ofCook IslandsCosta RicaCote d'IvoireCroatia/HrvatskaCubaCyprus IslandCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEquatorial GuineaEl SalvadorEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGreeceGhanaGibraltarGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (City Vatican State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsEswatiniSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaTogoTokelauTongaThailandTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (USA)Wallis and Futuna IslandsWestern SaharaWestern SamoaYemenYugoslaviaZambiaZimbabwe Address 1 * Address 2 City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaCanal ZoneCommonwealth of the Northern Mariana IslandsFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPhilippine IslandsPuerto RicoTrust Territory of the Pacific IslandsVirgin IslandsArmed Forces - AmericasArmed Forces - Europe, Canada, Middle East, AfricaArmed Forces - Pacific Zip / Postal Code * Terms 나는 프로그램의 비용이 KASEC 프로그램 기금으로부터 보조 받는다는 것을 인지하고 수락합니다. I understand and accept that program fees are subsidized by KASEC program fund. Korean American special education center is not responsible for any injury or accidents during the services provided by kasec. * I verify this information is true to the best of my knowledge. Applications with falsified information will not be considered.* I fully authorize and grant the Korean American special education center and its authorized representatives has my permission to use my or my child’s photograph publicly to promote the center. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.* The registration fee is required for all qualified applications. This fee is not refundable and cannot be credited against any other charges. I have read all of kasec student policies & behavior contract and understood them completely.* Show Terms Hide Terms By checking this box you acknowledge that you have fully read, understood, and agreed with the Policies. Total $300.00 {amount} donation plus {fee_amount} to help cover fees. Don’t have PayPal account? Click “Checkout as Guest” or “Pay with Debit or Credit Card” Read more