Request edit access
JA Play Lab School Application Form 2018/19
Please complete this form and submit to JA.
請填妥以下表格,並交回JA。
School Information 學校資料
English Name 英文名稱 *
Your answer
Chinese Name 中文名稱 *
Your answer
English Address 英文地址 *
Street No. & Street
Your answer
*
District
Your answer
*
HK/KLN/NT
Chinese Address 中文地址 *
Your answer
School Tel 學校電話 *
Your answer
School Fax 傳真號碼 *
Your answer
School Website 學校網址
Your answer
Head of School 校長
English Name 英文姓名 *
Sal 稱呼
*
Surname 姓
Your answer
*
First Name 名
Your answer
Chinese Name 中文姓名 *
Your answer
Email Address 電郵地址
Your answer
Office Tel. No. 辦公室電話
Your answer
Link Teacher 負責老師
English Name 英文姓名 *
Sal 稱呼
*
Surname 姓
Your answer
*
First Name 名
Your answer
Chinese Name 中文姓名
Your answer
Position 職位 *
Your answer
Office Tel No. 辦公室電話 *
Your answer
Mobile No. 手提電話 *
Your answer
Email Address 電郵地址 *
Your answer
Expected number of participating students 預計參與學生人數
(Minimum requirements: At least 2 whole grade participation and each grade with 100 or more students. For those interested in joining P1 or P2 program, enrollment to both sessions is a must for arrangement. )
申請基本要求:最少兩年級,全級學生參與,每級不少於100人。小一及小二課節會安排在同一日進行,如有興趣參加,需同時申請小一及小二課節才會獲考慮。
Primary 1 小一
Number of Classes 全級班數
Your answer
Total Number of Students 學生總人數
Your answer
Primary 2 小二
Number of Classes 全級班數
Your answer
Total Number of Students 學生總人數
Your answer
Primary 3 小三
Number of Classes 全級班數
Your answer
Total Number of Students 學生總人數
Your answer
Primary 4 小四
Number of Classes 全級班數
Your answer
Total Number of Students 學生總人數
Your answer
Primary 5 小五
Number of Classes 全級班數
Your answer
Total Number of Students 學生總人數
Your answer
Primary 6 小六
Number of Classes 全級班數
Your answer
Total Number of Students 學生總人數
Your answer
Language of Instruction 活動語言
*
Preferred Activity Schedule
*
(School can choose more than one options 可選擇多於一項)
Required
Program Dates 活動日期 *
1st Choice 第一選擇
MM
/
DD
/
YYYY
2nd Choice 第二選擇
MM
/
DD
/
YYYY
3rd Choice 第三選擇
MM
/
DD
/
YYYY
P1 & P2 Program Time 上課時間 (1 Hour for each grade plus at least 15 mins for changeover, the program time is at least 2 hours 15 mins, the earliest starting time 9:30 am; 每年級1小時,加最少15分鐘轉場時間;上課時間最少為2小時15分鐘,最早開課時間為早上9時30分) *
Start Time 開始時間
Time
:
*
End Time 結束時間
Time
:
P3 to P6 Program Time 上課時間 (1.5 Hour for each grade plus at least 15 mins for changeover, the program time is at least 3 hours 15 mins, the earliest starting time 9:30 am; 每年級1.5小時,加最少15分鐘轉場時間;上課時間最少為3小時15分鐘,最早開課時間為早上9時30分) *
Start Time 開始時間
Time
:
*
End Time 結束時間
Time
:
Declaration 聲明
I declare that the information given in this application is true and accurate, and confirm that this application has been endorsed and supported by the school. I hereby authorise JA Hong Kong to contact relevant parties and verify information given in this application form.

本人聲明此申請表格內之資料屬實及準確,並確定此申請已得到校方認可及支持。本人謹此授權青年成就香港部與有關人士聯絡,核實申請表格內之資料。

*
Name 姓名 *
Your answer
Position 職位 *
Your answer
Date 日期 *
MM
/
DD
/
YYYY
Please print a copy of this completed form for your record before submitting this form. 遞交前,請先列印已填妥的申請表以作記錄。
How do you know about this program? 從哪渠道得知此課程?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service