深圳维多利亚幼儿园VictoriaKindergartenShenzhen

Shanghai Victoria Kindergarten

2018-2019年度报名登记表Application Form

编号No：幼儿资料Applicant’s Information 请用正楷填写Please write in block capitals.

中文姓名Name in Chinese 英文姓名

Name in English

性别

Gender

出生日期Date of Birth 国籍Nationality

现居住住址Home Address 住址电话: Phone No.

证件类型Identification □身份证ID Card□通行证NRIC

□护照Passport

证件号码:

Identification #

户籍状态Household Registration 户口所在地

Nationality

□本市本区生

Resident of Shanghai

City and Local District

□本市非本区

Resident of Shanghai City

but Non-Local District

□外省市

Resident from other cities in

China

□香港Hong Kong □澳门Macau□台湾Taiwan□外籍Foreigner

现就读学校Current School:

●申请幼儿胞兄姊是否曾经/现正于本校就读

Has/Have the applicant’s sibling(s) studied/or are currently studying at a Victoria Kindergarten campus □否No□是Yes

胞兄姊姓名Name：就读年份Year(s) Attended：就读时班主任Class teacher：校舍Campus:

●申请人曾否报读本校? Has the applicant previously submitted applications to Victoria?

□否No □是Yes

申请年份Year applied 报读级别Class applied 申请校舍Campus applied

家长资料Parent’s Information

父亲Father 母亲Mother

姓名Name

国籍Nationality

最高学历及院校

Level of Education

And Name of Institution

职业/职务

Occupation/Position

就职单位Employer

电邮E-mail

移动电话Phone No.

照片Photo 照片

Shanghai Victoria Kindergarten

幼儿健康记录Child’s Health Record 曾有症状Medical History ：

□高热惊厥Seizures □哮喘Asthma □心、肺疾病Cardiovascular/Pulmonary Disease

□血液病Blood Disease □习惯性脱臼Recurrent dislocation of joints □其它 Others___________________ 是否食物过敏Any allergy to food?

□否No □是Yes 食物名称Name:_________过敏程度Allergic degree ：□轻度Mild □中度Moderate □重度Severe 是否药物过敏Any allergy to Medicine ？

□否No □是Yes 药物名称Medicine Name:____________

申請事項 Application Details

级别Class (请于适当的空格内以√号表示选择 Please √ the appropriate box to indicate your choice)

□小小班(Pre-K) 2015.9.1~2016.8.31出生之幼兒

Children who were born between 2015.9.1~2016.8.31. □小 班(K1) 2014.9.1~2015.8.31出生之幼兒

Children who were born between 2014.9.1~2015.8.31. □中 班(K2) 2013.9.1~2014.8.31出生之幼兒

Children who were born between 2013.9.1~2014.8.31.

学制Stream: 全日制双语国际班Whole Day International Bilingual Class

幼儿园资料收集声明 Personal Information Collection Statement 本 申请者所提交之个人资料，只会用作处理报读本机构之有关事宜。 All personal information collected will be used for application purposes only.

家长声明 Parental Agreement

本人确认此申请表的信息完整准确，同意并遵守维多利亚幼儿园的入学程序。如本人未准确提供申请人的入学信息，维多利亚幼儿园有权不接受该入学申请。

In signing this application, I certify that the information I have provided is complete, accurate and given in full. I also agree to comply with Victoria Kindergarten ’s admission procedure. If I have omitted important information or failed to complete the application in full , I understand and agree that Victoria Kindergarten reserves the right to restrict the applicant’s entry into the school.

家长签署Parent Signature: 日 期 Date ：