靈糧中文學校報名表 Bread of Life Chinese School Registration
Address: 2 Faraday, Suite B, Irvine, CA 92618
Tel: (949)600-7780
Fax: (949)600-7782
Email address *
通訊住址 Home Address *
Your answer
孩子的醫療保險 Child Family Medical Insurance Carrie and Policy Number *
Your answer
媽媽的英文姓名 Mother's English Name *
(Please provide us your FIRST and LAST name)
Your answer
媽媽的中文姓名 Mother's Chinese Name
Your answer
媽媽的手機號碼 Mother's phone number *
Your answer
媽媽的電郵 Mother's Email Address *
Your answer
爸爸的英文姓名 Father's English Name
(Please provide us you first name and last name)
Your answer
爸爸的中文姓名 Father's Chinese Name
Your answer
爸爸的聯絡電話 Father's phone number
Your answer
爸爸的電郵 Father's Email Address
Your answer
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