福智北加 Cupertino 德育班報名表

上課時間:星期天早上10AM-12PM
上課地點:10268 Bandley Dr #105 Cupertino, CA 95014 (又興中文學校)
詢問電話:李小文 (408)649-6489
報名資格:2歲至18歲的兒童及青少年
課程內容:每年約 26 週,秋季〈九月上旬~十二月中〉;春季〈一月下旬~五月中〉
每年學費 : $200 (第二個小孩優惠價爲 $180, 第三個小孩優惠價爲 $160, 以此類推)

由於名額有限, 若有缺額時會通知遞補. 不便之處尚請見諒.

Student Name *
English Name 英文名字
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Student Name
Chinese Name 中文名字
Your answer
Gender *
性別
Date of Birth *
mm/dd/yy 生日
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Parent(s)/Guardian Info *
English Name 家長英文名字
Your answer
Parent(s)/Guardian Info *
Chinese Name 家長中文名字
Your answer
Permanent Address
永久住址
Your answer
Phone Number 1
Home 家裡電話
Your answer
Phone Number 2
Mobile 手機號碼
Your answer
Phone Number 3
Work 工作電話
Your answer
Email Address *
電郵
Your answer
Emergency Contact Person *
Name 緊急聯絡人姓名
Your answer
Emergency Contact Person *
Phone Number 緊急聯絡人電話
Your answer
Emergency Contact Person *
Relationship 緊急聯絡人與學生的關係
Have your child attended our class before? *
請問您孩子曾參加過德育班嗎?
How do you know about our class? *
請問您如何得知福智德育班?
Required
Any other info you would like us to know about your child?
eg. allergy info... 是否有過敏或其他應注意事項?
Your answer
If you attend the Lamrim Class (廣論研討班), which class are you in?
eg. 08S3 請問您有參加廣論研討班嗎?請問是哪一班?
Your answer
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