培德青少年课后辅导報名表 Pui Tak Youth Program - After School Tutoring Registration Form (2016 Fall)
$25 报名费 $25 registration fee

9/6/2016 - 12/8/2016 (Fall)
Every Tuesday 週二 and Thursday 週四 5:15pm - 7:00pm
 提高英语水平: 会话, 听, 写, 阅读能力
 小组作业辅导
 协助青少年适应在美国的生活
 团体活动

English Name 英文名字 *
Your answer
Chinese Name 中文名字 *
Your answer
Gender 性別 *
Address 地址 *
Your answer
Cell Phone Number 手機號碼 *
Your answer
Home Phone Number 家庭電話號碼
Your answer
Email Address 電郵地址 *
Your answer
Additional Contact Method其他聯繫方式 (Wechat, Facebook, Whatsapp...)
Your answer
Date of Birth 出生日期 *
Your answer
Current School Attending 目前就讀學校 *
Your answer
Current Grade Level 当前年级 *
Language Skill 语言能力 (check all that apply 标记所有适用) *
Required
Family's Phone Number 家人电话号码 *
Your answer
Relationship with the student 与学生的关系 *
Your answer
By checking this box, I agree to give permission to Pui Tak Center, and its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize Pui Tak Center, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Pui Tak Center may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 选中此框,我同意给权限培德中心,其代表和员工带我和我的财产的照片与上述确定的主题连接正确。本人授权培德中心,其转让和受让著作权,使用和印刷和/或电子发布相同。我同意,培德中心可以使用我的带或不带我的姓名和任何合法的目的,例如照片,例如包括多种用途,如宣传,插图,广告和Web内容 * *
Please give registration fee of $25 to Tiffany (Pui Tak Center Rm 210). 請将 $25 报名费交给Tiffany (培德中心 210室). Please make check payable to Pui Tak Center. 支票: 請寫 "Pui Tak Center". *
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