入园登记表

附5 入园登记表 Enrolment Form

班级/Class: ________________ 幼儿学号/Student Number: ________________ 入学日期/Term Date: (老师填写/O ffice Use Only)

父母情况/PARENT DETAILS 父亲/Father/Guardian 姓名/Full Name: ……………………………………….…... 手机/Mobile: ………………………………………………..

国籍/Nationality: …………………………..………………. 语言/Languages Spoken: ………………………....……...

婚姻状况/Marital Status: ……………………………….…. 职务/Occupation: ………………………………………..… 工作单位/Work Name: ………………………………….… 工作地址/Work Address: ……………………………….… …………………………………………………….……….... 办公电话/Work Phone: …………………………………… Email Address : ……………………………………………

母亲/Mother/Guardian

姓名/Full Name: ……………………………………….….….. 手机/Mobile: ………………………………………………….. 国籍/Nationality: …………………………..……………..….. 语言/Languages Spoken: ……………………..…..…….…. 婚姻状况/Marital Status: ……………………………….…... 职务/Occupation: ………………………………………..….. 工作单位/Work Name: ………………………………….….. 工作地址/Work Address: ……………………………….….. …………………………………………………….……….…. 办公电话/Work Phone: ………………………………….…. Email Address : ………………………………………………. 幼儿情况/CHILD DETAILS 姓名/Full Name: …………………………………………. 性别/Sex: M F 出生年月/Date of Birth: ….../…../..…. 籍贯/国籍/Nationality: …………………………………... 民族/Ethnicity: …………………………………………………….. 语言会说/Languages Spoken: ………………………… 入园日期/Date to Start: ….../…../..…. 家庭住址 /Home Address: ……………………….. ……………………………………………………………………. 宅电/Home Phone: …………………………………….. 班级和课程模式/TYPE OF CARE REQUIRED : 中文班/Chinese Class 双语班/Bilingual Class 英文班/English Class 中餐/Chinese Food 西餐/Western Food 中西餐/Chinese & Western Food

寄宿/Boarding School

日托/Day Entry 自己接送/Parents bring/collect Child 园接送/Centre Drop Off/Pick up service

医疗情况/MEDICAL DETAILS

过敏反应/Allergies

您的孩子有过敏反应么？例如：过敏食物，药物，花草，防晒霜等

Does your child have any allergic reactions? E.g. Foods, medicine, grass, sunscreen, etc. Yes No

如有上述过敏反应，请告之详情/If yes, please provide details: …………………………………………………..……..………………………………………………………………………………………………………………………………………... 病史情况/ Medical Conditions

您的孩子有过病史记录么？例如：哮喘，惊厥等

Does your child have any medical conditions? E.g. Asthma, convulsions, etc. Yes No

如有上述记录，请告之详情/If yes, please provide details: ……………………………………………………………….…您孩子有经常服用的药物么？例如：哮喘药，等。

Does your child take any regular medication? E.g. Ventolin, etc. Yes No

如有上述情况，请告之详情/If yes, please provide details: ………………………………………………………………….

基本信息/GENERAL INFORMATION

食品/膳食/Food/Meals

您孩子有规定的食物么？例如：素食，宗教，信仰等

Does your child have any special dietary needs? E.g. Vegetarian, religious beliefs, etc. Yes No

如有上述情况，请告之详情/If yes, please provide details: ………………………………..………………………………... 基本需求/General Needs

您的孩子能参加节日庆典么？

Does/can your child participate in festivals/celebrations? Yes No

请详细告之/Please provide details: …………..………………………………………………………………………………其他/Other

您能对我们早教园提供帮助么？您有时间成为我们的志愿者么？

Can you contribute any skills to our centre’s program or have time to volunteer?

例如：会玩乐器，说不同的语言等/e.g. Play a musical instrument, speak other language, etc: ………………………... ………………………………………………………………………………………………………………………………………您为何选择ICC？例如：友好的教职工，环境干净整洁，气氛很好等，专业的中外籍教师，多元的双语学习，自然温馨的环境，独特的园文化等等.

Why did you choose ICC? E.g. Friendly, professional Teachers, cleanliness, Multi-cultural and bi-lingual Learning, Warm and Natural Environment, Aesthetic appearance, etc.: ……………………..……………….…………………….....