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安徒生和莫札特 SUMMER CAMP 報名表
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學員資料 Student Information
學員姓名 (Last, First Name)
*
Your answer
身分證字號 Identification No.
*
Your answer
出生日期 Birthdate
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(民國) 年/月/日 -- Y/M/D
Your answer
性別 Sex
*
男 Male
女 Female
Required
血型 Blood Type
*
Your answer
身高 Height
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公分 (cm)
Your answer
體重 Weight
*
公斤 (kg)
Your answer
就讀學校 Current School
*
Your answer
年級班別 Grade Level
*
年/班 Grade/Class
Your answer
住家地址 Home Address
*
Your answer
住家電話 Telephone Number
*
Your answer
藝術學習相關 Art Interests
舞蹈律動 Dance
美術繪畫 Fine Arts
戲劇 Theater
音樂 Music
Other:
Health Related
膳食習慣 Dietary Needs
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一般 Regular
全素 Vegan
奶蛋素 Vegetarian
Other:
Required
身體狀況 Medical History
*
健康 Healthy
過敏 Allergies
氣喘 Asthma
Other:
Required
**身體不適或特殊疾病或其他不適合參加團體活動者，請勿勉強報名參加。
*如有需要特別注意之健康狀況，請詳述
Your answer
報名梯次 Enrollment Information
2012年7~8月梯次 Session Dates
*
感謝大家的支持!!安徒生和莫札特的真.善.美夏令營，第二梯次7/16~7/21，以及8月所有梯次已團報額滿!!
Choose
7月9-14日
7月23-28日
是否住宿 Commuting/Dormitory Status
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不住宿，搭乘交通專車 Commuter with Transportation Service
住宿(二人房) Dormitory Service
Required
家長資料 Parent/Guardian Information
家長姓名 Parent/Guardian Name
*
Your answer
與學員關係 Relationship
*
Your answer
公司電話 Work Phone
Your answer
聯絡手機 Mobile
*
Your answer
E-MAIL
*
Your answer
緊急聯絡人 Emergency Contact
聯絡人姓名 Contact Name (1)
*
Your answer
與學員關係 Relationship
*
Your answer
緊急聯絡電話 Contact Phone (1)
*
Your answer
聯絡人姓名 Contact Name (2)
Your answer
與學員關係 Relationship
Your answer
緊急聯絡電話 Contact Phone (2)
Your answer
活動費用 Payment Method
1. 活動費用:
*
不需住宿之學員，新台幣13,000元整
選擇住宿之學員，新台幣18,000元整
Required
2. 繳款方式:
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** 活動開始後，因私人因素退出者，恕不退費。There will be no refund of tuition should you decide to cancel once the student(s)' session begins.
銀行匯款 Bank Account Wire Transfer
郵政劃撥 Postal Service Payment
即期支票 (掛號郵寄) Mail in Check
Required
家長 (或監護人) 同意書 Parent/Guardian Agreement
** 本人同意學員參加本梯次夏令營活動，並已了解各項報名規定。By registering, you understand and agree to all terms, conditions and guidelines provided by AM Creative.
*
For more information, please visit, 詳細規則：
http://www.summercamp.amgroup.com.tw/qas.html
同意 I agree.
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