Student Background Form
This form is split into 6 sections and it will take about 15 minutes to complete it.  The data is only saved upon its submission at the end.  

The information collected here is for the Kids Connect team to get to know the learner's background as well as his immediate community  It is for internal use only and is kept confidential.  

Thank you for taking your time to helping us get to know your child.  
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Date of Application *
MM
/
DD
/
YYYY
What program are you interested in? *
Required
Child's First and Middle Name *
Surname: *
Name in Chinese:
(If applicable)
Date of Birth *
MM
/
DD
/
YYYY
Nationality *
School Currently Attending
Grade
Class Time in School
Clear selection
Sex
Clear selection
Home Address *
Home Phone Number
Where did you hear about us?
Clear selection
Can you provide a name or an organization for our reference only.
Next
Clear form
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