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躍動專注大本營(幼稚園)--感覺統合及專注力 報名表格
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如所選擇之課程已滿額，將會被安排到輪候隊伍
兒童姓名：
*
Your answer
是否曾經在本中心進行評估或訓練：
*
是
否
電子郵件：
*
請填寫有效電子郵件,中心將會寄出確認電郵
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性別：
*
男
女
出生日期：
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MM
/
DD
/
YYYY
年齡：
*
Your answer
就讀中心/學校名稱 (班別)：
*
Your answer
家長姓名：
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通訊地址：
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日間聯絡電話/手提：
*
Your answer
請家長簡述孩童(在家中/學校)的關注事項：
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參加組別
A組(逢三)
B組(逢六)
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