Application Form報名表格
*表格上的個人資料,只供本中心作申請報名記錄、緊急聯絡及會員通訊之用,個人資料絕對保密。
The personal data on the form is only for the application of the registration record, emergency contact and member communication. The personal data is absolutely confidential.
學童姓名 (中) *
Your answer
學童姓名(English name)
Your answer
年齡(Age) *
Your answer
性別(Gender) *
出生日期(Date of Birth) *
MM
/
DD
/
YYYY
家長聯絡電話(Phone number) *
Your answer
家長電郵(Email address) *
Your answer
地址(Address)
Your answer
確診 (Diagnosis)
Your answer
食物敏感 (Food Allergy)
Your answer
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