Application Form 報名表
Application Form 報名表
Student 學生資料
Name in Chinese 中文姓名
Last Name in English 英文姓氏
Middle Name in English 英文名字
Contact Number 聯絡電話
Learning Expectation
Student Personal Information 個人資料
Date of Birth 出生日期
/
DD 日
/
MM 月
YYYY 年
Age 年歲
Sex / Gender 性別
Female 女
Male 男
Nationality 國籍
Religion 宗教
Unique Habit 特殊習慣
Have you ever moved? When? 搬遷次數
Home Address 住址
Mailing Address 郵寄地址
Family Members 家庭成員
Hobbies 嗜好
Favorite Food 喜愛食物
Any problem you are currently suffering? 現正面對之煩惱
Issue 問題
Period 期間
Has he/she had any injury? 受傷經歷
Yes 有
No 無
When? 時間
How about before?
Any specific illness?
Period
Any bad habit/temper you want him/her to get rid of 想改變之問題
Period
Any test he/she did before? Ex: IQ, EQ, Psychological……….. 過往測試報告(如有)
Most of the time, who take care him/her? 主要誰人照顧?
Family day? How many times per month? 家庭日? 每月?天
Where did you go? 假期所到地方
Other information: 其他資料
Student School Information 學校資料
Name of School 學校名稱
Class 年/班別
School Time 上課時間
School Records 成績
Teacher’s Comment 老師評語
Remarks 備註
Merit 優點
Demerit 缺點
Past Leisure courses 過去學習之興趣課程/活動
1)
Period 期間
2)
Period 期間
3)
Period 期間
4)
Period 期間
5)
Period 期間
Remarks
Past Activities
1)
Period
2)
Period
3)
Period
4)
Period
5)
Period
Remarks
Present leisure courses he/she is currently taking? 現正參加之課程
1)
Period
2)
Period
3)
Period
4)
Period
5)
Period
Remarks
Present Activities
1)
Period
2)
Period
3)
Period
4)
Period
5)
Period
Remarks
Parents Information 家長資料
Father’s Name in Chinese 父中文名字
Father’s Last Name in English 父英文名字
Father’s Middle Name in English
Occupation 職業及教育程度
Phone number 聯絡電話
Mother's Name in Chinese 母中文名字
Mother's Last Name in Chinese 母英文名字
Mother's Middle Name in Chinese
Occupation 職業及教育程度
Phone number 聯絡電話
Marital Status 婚姻狀況
No. of children 子女人數
Email 電郵地址
Fax 傳真號碼
Your Name