Application Form 课后美术班报名表
| English Full Name 英文全名 | Chinese Name 中文全名 |
Date of Birth 出生日期 |
Age 年龄 | |
| School 学校 | Grade 年级 | Class Room No 教室号码 |
||
| Residence Address 住址 | City 城市 | Postal Code 邮编 | ||
Emergency Contact 紧急联络人
| Parent's Name 家长姓名／紧急联络人 | Home Tel 家庭电话 | Mobile Tel 手机电话 |
| Occupation 职业 | E-mail 电邮地址 | |
Fee 费用
| Period 日期 | Time 3:05pm - 5:05pm 时间 |
Fee 费用 | Total Fee 总费用 |
Early Bird 6月24日 前报名优惠 |
| A14 (18 classes) | ⃞ Every Wed | $7.4 x 16 hrs + $8 material fee |
$126.40 | $118.40 |
| B14 (7 classes) | ⃞ Every Wed | $7.40 x 14 hrs + $7 material fee |
$110.60 | $106.50 |
Please check ⃞ either box below 请选择以下其中一项
⃞ I would like to enclose a cheque of 本人于此时附上价值为$__________ for period A14 的支票作为A14的学费
Or
⃞ I would like to enclose a cheque of 本人于此时附上价值为$__________ for period A14 and B14 的支票作为A14和B14的学费
Parent Signature 家长签名:____________________ Date 日期:__________
Based on operation practice, student may have to attend the class on the alternative day of the week. 由于运行上的限制，学生可能需要调整每周的上课日。
Please fill in the form above and submit together with a cheque payable to Alive Art and Culture Workshop to the School office.
请填妥以上表格，连同支票（请支付 Alive Art and Culture Workshop）齐交往校务处。