Pre-Registration Form 报名表
Please fill out one from for each child 请为每位幼儿填写一份
Chil d Information 幼儿信息
Age Level Requested 申请年龄班
Parent Information 家长信息
General Information
For Office Use Only 园方记录
English Name_________________________________ Family name_________________________________________ 中文姓名______________________________________ 姓名拼音_____________________________________________
Birth Date 生日：Year 年________ Month 月_______Day 日______ Birthplace 出生地________________
Nationality 国籍______________________________________________
Gend er 性别_______________________ Student First Language 母语________________________ Second Language 第二语言__________________________________
Has your child attended any additional school programs (i.e. gifted and talented or emotional/behavioral disorder, learning difficulty, speech or language therapy, etc/) 您的孩子有没有接受特殊教育？（如超智力训练，情感行为自控能力，学习困难，语言障碍方面的治疗等）？Yes 是No 否
If yes, please provid e details: __________________________________________________________________________________________ Mother’s Name 母亲姓名__________________________________Father’s Name 父亲姓名_______________________________ Home Address 家庭地址______________________________________________________________________________________________ Contact Number 联系电话home 家庭___________________Mobile 手机_____________________Fax ___________________ E-mail address 电子邮件______________________________________________________________________________________________ Date Received 收件日期_______________ Planned Starting Date 预计入学日________________________________ Waiting List No 等候号________________ Class Assigned 入学班级____________________________________________ Remarks 备注_________________________________________________________________________________________________________ Signature 签名 Date 日期
