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.: ……………………..……………….…………………….....
接送授权/紧急联系方式/Authority to Collect/Emergency Contacts:
(不包括父母的名字/Do not include Parent/s name/s)
我授权无锡爱儿星国际早期教育园的老师能让下列人接近我的孩子。

请保证以下表格中的人在发生紧急情况时愿意并能够接我的孩子。

至少填写两位的联系方式。

I authorize the staff members of International Child Care (ICC) to give the following persons access to my child. Please ensure these emergency contact persons are willing and able to collect your child in the event of an emergency. At least 2 contact names must be completed before enrolment commences.
Permission
我授权爱儿星国际早期教育园教职工：
I give the management/staff of International Child Care (ICC) the authority:
♦我的孩子能参加幼儿园的各项参观及春秋游活动
For my child to take part in excursions from the centre.Yes No ♦我孩子的名字和照片能给幼儿园用于展示，奖励之途，包括媒体等
To use the name and/or photo of my child for the centre displays
and/or promotional use, including media. Yes No
♦能按照我确认的方式接送我的孩子
To transport my child to and from home with my agreement Yes No
（如果以前有要求就按照以前的/ If previousl y requested-See Type of Care Required）
♦能给孩子涂防晒霜
To apply sunscreen for outside play. Yes No ♦为了孩子更好地发展，教师可以对孩子进行观察并记录
To be observed by teachers for developmental purposes. Yes No ♦表格中填写的父母和联系人都有权从幼儿园接孩子，除非有其他说明
The persons listed as Parents & Contact Persons are authorized to drop off Yes No
and collect my child from the centre unless otherwise specified.
♦我同意遵守幼儿园的各项规章制度。

I agree to abide by ICC’s Policies and Procedures. Yes No
父母签名/姓名/Parent/s Signature &
Name: ………………………………………………………………………………..…
日期/Date: …………/………./……….
紧急医疗处理/Medical Emergency
如有事故或紧急事件发生，将会尽一切努力立刻联系父母。

如果事故要求对孩子立即用药处理，我授权爱儿星国际早教园的教职工可以辅助医生处理.
In case of accident or emergency, every effort will be made to contact the parent/s immediately. In the event that my child requires medical attention, I authorize the staff of International Child Care (ICC) to obtain medical assistance.
父母签名&名字/Parent/s Signature & Name: …………………………………………………………………………………。