基督教家庭服務中心德田幼稚園/幼兒園
暫託幼兒服務申請表 Application Form for Occasional Child Care Service

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請於家長每月14及28日申請下兩週的暫託服務,以惠及更多有需要的家庭。

費用 Fee︰全日暫託 Full day  $64
                   半日暫託 Half-day $32
                   每兩小時 A session of 2 hours $16
                   另加膳食 Additional charges for meals $6.5
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1. 兒童資料 Child Information
兒童姓名(中/英) Student Name(Chi/Eng) *
出生日期 Date of Birth *
MM
/
DD
/
YYYY
年齡 Age *
性別 Gender *
就讀學校 School Attending
2. 父母/監護人資料 Parents / Guardian's Information
家長/監護人姓名 Paren / Guardiant’s Name *
與兒童關係 Relationship with Child *
身份證號碼 Identity Card No. *
職業 Occupation *
電話 Contact No. *
住址 Address *
3. 緊急聯絡資料 Emergency Contact Information
緊急聯絡人姓名 Emergency Contact Name *
與兒童關係 Relationship with Child *
電話 Contact No. *
4. 受託原因 Reason for Application *
5. 轉介來源 Source of Referral *
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